Waiver Form

Spark Play Cafe, LLC
Waiver and Release of Claims for Minor Participant

In consideration for permission to participate in activities at and to access the property and facilities of Spark Play Café, LLC, I, the parent/guardian of the minor indicated below (hereinafter, “Participant”), hereby agree to indemnify, defend, and hold harmless Spark Play Café, LLC, and its officers, directors, employees, volunteers, agents, affiliates, and all others who could be held liable (collectively, “Spark Play Cafe”) from and against any and all claims, causes of action, lawsuits, losses, costs, damages, expenses (including, but not limited to, attorneys’ fees) and liabilities due to any injury to or death of any person, or damage to or loss of any property, arising out of or related to Participant’s participation in such activities. I also hereby specifically agree to waive and release any and all claims against Spark Play Cafe arising out of or related to any such activities.

I certify that, to the best of my knowledge and belief, Participant has no known medical problems or conditions that would prevent him/her from participating in the above-referenced program or activities at Spark Play Cafes’ facilities. I acknowledge that Spark Play Cafe does not provide health or accident insurance coverage to participants. I agree to be financially responsible for any such emergency medical treatment/services and represent that I have adequate insurance and financial resources to do so. I hereby waive, release, discharge, and agree to indemnify, defend and hold harmless Spark Play Cafe from and against any and all liability, loss, damage, and claims of any nature which in any manner arise from or relate to such services or treatment.

I understand that my child’s participation in the above-referenced program or activities is performed under this specific understanding. I have read and understand the foregoing and voluntarily sign this Waiver and Release of Claims with full knowledge of its contents and significance.