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

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.

RELEASE AND WAIVER OF LIABILITY

 

PLEASE READ ALL SECTIONS CAREFULLY! THIS IS A LEGAL DOCUMENT THAT AFFECTS YOUR LEGAL RIGHTS.

 

The individual named below (referred to herein as the “Individual”) desires to participate in activities and events (the Activities”) provided by Inspired Play Café LLC, a Kansas limited liability company (the “Company”), and use the facilities of the Company located at located at 6527 West 119th Street, Overland Park, KS 66209 (the “Property”). In consideration of being permitted by the Company to participate in the Activities and enter the Property, and in recognition of the Company’s reliance hereon, the Individual, and the Individual’s parent or legal guardian (if the Individual is a minor), does hereby agree to all the terms and conditions set forth in this instrument (this “Release”).

 

1. INDIVIDUAL IS AWARE AND UNDERSTANDS THAT THE ACTIVITIES ARE A POTENTIALLY DANGEROUS ACTIVITY AND INVOLVES THE RISK OF SERIOUS INJURY, DISABILITY, DEATH OR PROPERTY DAMAGE. PARTICIPANT ACKNOWLEDGES THAT ANY INJURIES THAT HE OR SHE SUSTAINS MAY RESULT FROM OR BE COMPOUNDED BY THE ACTIONS, OMISSIONS OR NEGLIGENCE OF THE COMPANY, INCLUDING NEGLIGENT EMERGENCY RESPONSE OR RESCUE OPERATIONS OF THE COMPANY. NOTWITHSTANDING THE RISK, PARTICIPANT ACKNOWLEDGES THAT HE OR SHE IS VOLUNTARILY PARTICIPATING IN THE ACTIVITIES WITH KNOWLEDGE OF THE DANGER INVOLVED AND HEREBY AGREES TO ACCEPT AND ASSUME ANY AND ALL RISKS OF INJURY, DISABILITY, DEATH OR PROPERTY DAMAGE ARISING FROM THE ACTIVITY, WHETHER CAUSED BY THE ORDINARY NEGLIGENCE OF THE COMPANY OR OTHERWISE.

 

2. Individual hereby expressly waives and releases any and all claims, now or hereafter known, against the Company, and its officers, directors, managers, employees, agents, affiliates, members, successors and assigns (collectively, “Releasees”), arising out of or attributable to Individual being on the Property or Individual’s participation in any of the Activities, whether arising out of the ordinary negligence of the Company or any Releasees or otherwise. Individual covenants not to make or bring any such claim against the Company or any other Releasee, and forever release and discharge the Company and all other Releasees from liability under such claims. This waiver and release does not extend to claims for liabilities that are not permitted to be released by agreement under the laws of the State of Kansas.

 

3. Individual agrees to follow all instructions of any employee, staff member or other representative or agent of the Company while on the Property. Individual hereby consents to receive medical treatment deemed necessary if Individual is injured or requires medical attention while at the Property or during his or her participation in the Activities. Individual understands and agrees that he or she is solely responsible for all costs related to such medical treatment and any related medical transportation or evacuation. Individual hereby releases, forever discharges, and holds harmless the Company from any claim based on such treatment or other medical services.

 

4. This Release constitutes the sole and entire agreement of the Company and Individual with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations and warranties, both written and oral, with respect to such subject matter. If any term or provision of this Release is invalid, illegal or unenforceable in any jurisdiction, such invalidity, illegality or unenforceability shall not affect any other term or provision of this Release or invalidate or render unenforceable such term or provision in any other jurisdiction. This Release is binding on and shall inure to the benefit of the Company and the Individual and our respective successors, assigns, heirs, executors and personal representatives. All matters arising out of or relating to this Release shall be governed by and construed in accordance with the internal laws of the State of Kansas without giving effect to any choice or conflict of law provision or rule (whether of the State of Kansas or any other jurisdiction). Any claim or cause of action arising under this Release may be brought only in the federal and state courts located in Johnson County, Kansas and I hereby consent to the exclusive jurisdiction of such courts.

 

I agree that I specifically read the above Release & Waiver of Liability

 

 

 

COVID-19 RELEASE

 

ASSUMPTION OF THE RISK & WAIVER OF LIABILITY RELATING TO COVID-19

 

By signing this agreement, I, Individual, acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that myself or my child(ren) may be exposed to or infected by COVID-19 by visiting Inspired Play Café LLC (“Business”) and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the Business may result from the actions, omissions, or negligence of myself and others, including, but not limited to, all prior named Releasees, Business employees, agents, independent contractors, vendors, affiliates, successors and assigns (Collectively the “Released Parties.”)

 

I, Individual, voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself or my child(ren) (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my attendance at the Business (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless the Business, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Business, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after visiting the Business. I agree to indemnify, defend, and hold harmless the Released Parties from and against any and all costs, expenses, damages, claims, lawsuits, judgments, losses, and/or liabilities (including attorney fees) arising either directly or indirectly from or related to any and all claims made by or against any of the Released Parties due to bodily injury, death, loss of use, monetary loss, or any other injury from or related to my use of the Business, tools, equipment, or materials, whether caused by the negligence of the Released Parties or otherwise specifically related to COVID-19.

 

By signing below I, Individual, acknowledge and represent that I have read the foregoing Waiver of Liability, understand it and sign it voluntarily as my own free act and deed, including without limitation the Release of Liability and Indemnification requirements contained in this document; I am sufficiently informed about the risks involved in visiting the business to decide whether to sign this document; no oral representations, statements, or inducements, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age and fully competent; and I execute this document for full, adequate, and complete consideration fully intending to be bound by the same. I agree that this Waiver of Liability shall be governed by and construed in accordance with Kansas law, and that if any of the provisions hereof are found to be unenforceable, the remainder shall be enforced as fully as possible and the unenforceable provision(s) shall be deemed modified to the limited extent required to permit enforcement of the Waiver of Liability as a whole.

 

I agree that I specifically read the above COVID-19 Release

 

 

MEDIA RELEASE

 

I, Individual, for consideration which I acknowledge, consent to the use of my photo(s), social media post(s), statements, or other items (the “Work”), and grant to Inspired Play Café LLC (“Company”) and Company's assigns, licensees and successors the right to copy, reproduce, and use all or a portion of the Work for incorporation in Company’s social media, print media, marketing, emails and advertisement.

 

I grant the use of all or a portion of the Work and any of its derivatives in all forms and media electronic, print and other, including advertising and related promotion throughout the world and in perpetuity without compensation. I grant the right to use my name or pseudonym in connection with all uses of the Work and waive the right to review or approve use of the Work.

 

I release Company and Company’s representatives, including all prior named Releasees and Released Parties, officers, assigns, licensees and successors from any claims and demands that may arise regarding the use of the Work including any claims of defamation, invasion of privacy, or infringement of moral rights, rights of publicity or copyright and any other personal and/or property rights. I acknowledge that I have no ownership rights in the Work. Company is not obligated to utilize the rights granted in this Agreement.

 

I acknowledge and agree that no sums whatsoever will be due to me as a result of the use and/or exploitation of the “Work” or any rights therein.

 

I have read and understood this agreement and I am over the age of 18 and/or my parent or legal guardian signs this document on behalf as if I signed as an adult. This Agreement expresses the complete understanding of the parties.

 

I agree that I have specifically read the above Media Release

 

BY SIGNING, PARTICIPANT ACKNOWLEDGES THAT HE OR SHE HAS READ AND UNDERSTOOD ALL OF THE TERMS OF ALL ABOVE RELEASES AND WAIVERS, AND THAT HE OR SHE IS VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE THE COMPANY.

 


I acknowledge I have read and understand this waiver and certify that all personal information is correct.
I wish to allow my email to be used for marketing purposes.
By signing this waiver, I agree that all information is complete and accurate.