Waiver

Please fill out the following form.

First name of responsible adult over 18 years

Last name of responsible adult over 18 years

Name and birthdate of child 1 if applicable

Name and birthdate of child 2 if applicable

Name and birthdate of child 3 if applicable

Name and birthdate of child 4 if applicable

Name and birthdate of child 5 if applicable

Queen of Hearts Academy Inc. - QYC Fun Factory Waiver of Liability

I understand and acknowledge that the use of the QYC Fun Factory indoor playground equipment and facilities involves inherent risks, including but not limited to the risk of physical injury, illness, and death. In consideration of being allowed to use the facilities and equipment provided by the QYC Fun Factory, I hereby agree to release, waive, discharge, and covenant not to sue the QYC Fun Factory, Queen of Hearst Academy Inc, its owners, employees, agents, and representatives (collectively, the "Released Parties") from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me or any third party, whether caused by the negligence of the Released Parties or otherwise, while using the indoor playground facilities and equipment.

I acknowledge that I have been advised to obtain medical clearance from my physician before using the QYC Fun Factory facilities and equipment. I further acknowledge that I have read and fully understand this waiver of liability, and that I am freely and voluntarily executing it.

I agree that this waiver of liability shall be binding upon me, my heirs, executors, administrators, and assigns. I further agree to indemnify and hold harmless the Released Parties from any claims, damages, or losses arising out of my use of the QYC Fun Factory facilities and equipment. I further consent to the jurisdiction and venue of any court of competent jurisdiction located in the state and county where the QYC Fun Factory is located for any legal disputes arising out of or related to this waiver of liability.

I acknowledge and accept all risks associated with using the QYC Fun Factory facilities and equipment and understand that Queen of Hearst Academy Inc and the QYC Fun Factory cannot guarantee my safety or that of a child’s from any inherent risks.

I agree to the terms of this waiver

I acknowledge that by submitting this form, I accept the terms of this electronic waiver as a legally binding document

Acknowledgement of waiver terms

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