Complete a waiver for myself
Complete a waiver for myself and children
Viewing the video is required before you can proceed to next step.

Adult Information

( Indicates a required field )

( Age must be at least 18 years old )

Contact Information

Participants

Liability Waiver

Please read the waiver below and fill out the required fields found in the following form sections. All liability language from the waiver will apply to all persons listed below.


FACILITY USE AGREEMENT

In consideration of being allowed to enter the facility, play area and/or participate in any party and/or program at Busy Bean Play Cafe, LLC, the undersigned, on his or her behalf, and on the behalf of the “participant(s)” identified below, acknowledges, understands, and agrees to the following conditions:

  1. I represent that I am the responsible party, being a parent or legal guardian of the child or children (“participant or participants”) named below, or I have obtained permission from the parent/legal guardian of the participant(s) named below to execute this agreement on their behalf. 
  2. I understand and agree that I am the responsible party for the safety and behavior of the “participant(s)” I register while they are present at the Busy Bean Play Café facility.  I understand and agree that I can NOT be responsible for more than four (4) “participants” and myself at any one time while present at the Busy Bean Play Café facility.
  3. I agree that the “participant(s)” named below, and I shall comply with all stated and customary terms, posted safety signs, rules, and verbal instructions as conditions for participation in any sponsored programs, activities, parties, and the general use of the play area at Busy Bean Play Café facility. In addition, if I observe any hazard during our participation, I will bring it to the attention of a Busy Bean Play Café employee immediately.  I understand that I am responsible for the “participant(s)” named below and for the “participant(s)” safety and behavior at all times while the “participant(s)” is present at the Busy Bean Play Café facility. 
  4. I understand that the “participant(s)” I am claiming responsibility for will remain in my clear view at all times during my visit and that I will properly supervise the “participant(s)” named below for which I acknowledge responsibility.
  5. I, for myself and the “participant(s)” named below, and our respective heirs, assigns, administrators, personal representatives, and next of kin, hereby release and hold harmless, Busy Bean Play Cafe, LLC, the Busy Bean Play Café owners, management, their affiliates, officers, members, agents, employees, other participants, and sponsoring agencies from and against any and all claims, injuries, liabilities or damages arising out of or related to our presence and participation in any and all Busy Bean Play Café sponsored programs, activities, parties, and including the general use of the play area. 
  6. I further agree for myself, the parent or legal guardian of the “participant(s)” named below, to fully indemnify and reimburse Busy Bean Play Cafe, LLC, Busy Bean Play Café owners, management, their affiliates, officers, members, agents, employees for any and all damages and injuries caused myself or the “participant(s)” listed below to include, but not limited to: damage or injury to persons or property at the Busy Bean Play Café facility. 
  7. I, for myself and the “participant(s)” named below, have read and will abide by all posted rules, including, but not limited to: wearing socks inside of the play area, ensuring only children within the age limit (18 months and under) enter the labeled gated area, refraining from running, and refraining from throwing or misusing toys in any way. I also understand that there is absolutely no food allowed inside the play area at any time. I understand that in order to play, my child must be well and free of any communicable/contagious illness.

Note: We reserve the right to deny service to any child or adult who may appear ill and also require a doctor’s note for any ill child to return. We also reserve the right to ask any guest who does not adhere to this signed agreement to leave without a refund.

  1. I agree that I have disclosed all health conditions, including allergies, for which Busy Bean Play Café owners, management, employees, their affiliates, officers, members, agents, and other “participant(s)” should reasonably be made aware and that are relevant to the wellbeing of the “participant(s)” for which I am responsible, and the other persons present at the Busy Bean Play Café facility.
  2. I grant permission to Busy Bean Play Café, LLC and its agents and employees the irrevocable and unrestricted right to reproduce the photographs and/or video images taken of me, or members of my family, for the purpose of publication, promotion, illustration, advertising, or trade, in any manner or in any medium. I hereby release Busy Bean Play Café, LLC and its legal representatives for all claims and liability relating to said images or video. Furthermore, I grant permission to use my statements that are given at the facility, with or without my name, for the purpose of advertising and publicity without restriction. I waive my right to any compensation from and for the use of these images and statements.

I represent and acknowledge that I am at least 18 years of age and that I am mentally and legally capable of understanding and executing this agreement. 

Note: The responsible party executing the waiver may designated a 16- or 17-year-old person as a “surrogate” responsible party to be present with the participants. It will be the obligation of the Responsible Party to inform the “surrogate” responsible party of the terms of this Agreement and that they understand the terms of the agreement.  

 

 


By signing this waiver, I agree that all information is complete and accurate.