Registration
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Open Play Waiver
Event:
Start Date/Time:
End Date/Time:
Fee per Student:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Home Phone:
Cell #:
Work #:
Email:
*
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Students entered below will be added to your family's account
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Birth Date:
*
(format=mm/dd/yyyy)
Allergies (Leave blank if NONE):
Additional Information:
Assumption of Risk
(Show-Hide Details)
I understand that there are risks of physical injury associated with, arising out of, and inherent to the participation in any play event. In recognition of the acknowledged risk of injury, I knowingly and voluntarily waive all right and/or causes of action of any kind, including all claims of negligence arising as a result of such activity from which liability could accrue to The Once Upon A Time Center, its' members, officers, agents, employees, instructors, assistants, subsidiaries, and all affiliated entities (hereinafter collectively referred to as "The Once Upon A Time Center".
I've read the above and agree.
Release of Liability
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I hereby agree to release The Once Upon A Time Center and hold The Once Upon A Time Center harmless of all liability, and hereby acknowledge and I knowingly assume full responsibility for all risks of physical injury or illness, including but not limited to Covid-19, arising out of active participation in any play event on behalf of the participant. I am aware that this is a release of liability and an acknowledgement of my voluntary and knowing assumption of the risk of injury. I have signed this document voluntarily and of my own free will in exchange for the privilege of participation. I understand that I should be aware of my physical limitations and that of my child(ren), and agree not to exceed them. If I am signing this waiver for my children, I certify that I am the parent or legal guardian and have the right to waive these rights.
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
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