In consideration for participation in activities at Grandma Jane's Playhouse, I hereby agree on my behalf and on behalf of the minor(s) listed below to the following: I understand that participation in Grandma Jane's Playhouse activities are risky and that risks of injury include without limitation; scrapes, bruises, cuts, and even more serious injuries, such as paralysis or death. I fully accept and agree to assume all of these risks (including risks arising from the negligence of other participants), for myself and all children listed below. I understand that it is my responsibility to supervise the children listed below when they are participating in activities at Grandma Jane's Playhouse, not the responsibility of Grandma Jane's Playhouse. I will remain on the premises of Grandma Jane's Playhouse while the minors listed below are attending. I will obey and will make sure that all children listed below obey the rules posted at Grandma Jane's Playhouse. I understand that violation of rules could result in expulsion from Grandma Jane's Playhouse with no monetary reimbursement. I agree and understand that this agreement is binding on myself, and all the children listed below and the heirs, successors and assigns of myself, all my children listed below. By signing below, I, for myself and all the children listed below, herby release, and forever discharge Grandma Jane's Playhouse, from all manner of actions, suits, claims for relief, damages and demands for injury occurring at, in, or in any way related to Grandma Jane's Playhouse. I certify that I am the legal parent or guardian of the child/children for whom I am signing. I understand that this is a permanent waiver to be kept on file by Grandma Jane's Playhouse for today’s visit and all future visits.


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Date: 1/25/2024

Time: 1:48 PM

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Submission Sequence: 2024-02-08T17:53:21.322Z240
DUUID Sequence: KV2YSZ9QEKG_af0d8b39-1620-4e37-8acf-2bb7f58897e7
IP(s): 108.231.121.165, 18.68.41.40
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UA: Mozilla/5.0 (Macintosh; Intel Mac OS X 10_15_7) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/121.0.0.0 Safari/537.36