Digital Registration and Release Form
* **This waiver is required to enter Jungle Jac's Play Center. Please complete it in full. You must be at least 18 years of age in order to sign a waiver. If you are NOT 18 years old please have your parent or guardian sign this form on your behalf. **

Release of Liability, Waiver of Claims, Assumption of Risks, and Indemnity Agreement.
By digitally signing this document below, you will waive certain legal rights, including the right to sue.

**PLEASE READ CAREFULLY**

In consideration of Jungle Jac's Play Center Ltd. allowing the Child and the Child's Parents, Guardians and Caretakers to use their facilities (here in after referred to as "the Premises) for the duration of the Waiver Term, I hereby for myself, the Child as well as our heirs, executors, administrators, assigns or anyone else who might claim on their behalf warrant and agree as follows:

1.) To waive any and all claims that I have, with any adults accompanying me, or the child may have, now or in the future Jungle Jac's Play Center Ltd. and its Directors, Officers, employees, agents, and representatives (all of whom are here in after collectively referred to as "the Release-es").

2.) To release and discharge the Release-es from any liability from any and all loss, damage, injury, or expense to person or property that I or the Child may suffer as a result of the child using the premises, or being inside the premises, playing on or using in any fashion the equipment located within the premises, due to any cause whatsoever, including negligence on the part of the release-es.

3.) To hold harmless and indemnify the release-es from any and all liability for any property damage or personal injury to any third party, resulting from the child using the premises and the equipment located within the premises.

4.) To indemnify the release-es from all costs and claims brought against the release-es on behalf of the child, the child's parents, guardians or caretakers of any other person acting on behalf of the child in any capacity whatsoever.

5.) To indemnify the release-es from all costs and claims brought against the release-es on my own behalf or by any other person or corporation acting on my behalf in any capacity whatsoever.

6.) That I have read the release-es safety rules and have ensured that the child has been made aware and understands them and I hereby warrant that I also have read, understood and agree to abide by the said Safety Rules. I warrant that the child is in good physical condition and physically able to play in the premises and that the child is old enough to participate.

7.) That I acknowledge that playing in the premises and making use of the equipment situated at the premises (climbing structure, bumpercars, lazer tag, trampolines and inflatables) does involve a certain normal inherent risk of injury and that I am prepared to accept that risk on my behalf and on behalf of the child and I do hereby assume the liability for any injury incurred by myself or the child as a result of the use of the premises and the equipment contained therein.

8.) That I am either the child's parent or guardian, or I have been duly authorized by the parent or guardian to execute this waiver on their behalf.

9.) That this agreement shall be effective and binding upon my heirs, next of kin, executors, administrators, and assigns's.

JUNGLE JAC'S PLAYCENTRE

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YOU MUST AGREE TO THE TERMS ABOVE IN ORDER TO PROCEED......THANK YOU



* Please provide your phone number
 

What City are you from?
 

* Child's First and Last Name
 

* How old?
 

Please list adults who will remain with your group that is taking part in any Jungle Jac activities eg:trampolining, bumper cars, lazer tag, jungle climb etc.
 

First and Last name separated by comma



* Adult First and Last Name
 

*****Please fill in your FULL NAME below in the Digital Signature "Your Name" question so we can find you next time*****



YOUR FORM HAS BEEN COMPLETED PLEASE PROCEED TO THE FRONT THANK YOU!!! THANK YOU!!! THANK YOU!!! THANK YOU!!! THANK YOU!!! THANK YOU!!! THANK YOU!!! THANK YOU!!! THANK YOU!!! THANK YOU!!! THANK YOU!!! THANK YOU!!! THANK YOU!!! THANK YOU!!! THANK YOU!!! THANK YOU!!! THANK YOU!!! THANK YOU!!! THANK YOU!!! THANK YOU!!! THANK YOU!!! THANK YOU!!!

Digital Signature

Please be patient, it might take awhile for your inquiry to be submitted. Do not click Submit more than once.