PLAYZONE AT MERCY ROAD CHURCH WAIVER & RELEASE OF LIABILITY

Welcome!
To ensure a safe and enjoyable experience for all families, we require a completed waiver for each participating child age 12 and under before using the indoor playground. This helps us maintain a safe environment, communicate important guidelines, and clarify responsibilities. Thank you for helping us provide a fun and secure space for your family.

Your name *

Email address *

Phone number

Address

CHILD(REN) INFORMATION Please list all children who will be participating

Please list all children who will be participating

WAIVER AND RELEASE OF LIABILITY

I, the undersigned parent or legal guardian, hereby acknowledge and agree to the following on behalf of myself and all children listed above:

Assumption of Risk *

I understand that participation in activities at the Mercy Road Church indoor playground involves inherent risks of physical injury. I voluntarily assume full responsibility for any risk of injury, illness, damage, or loss that may arise from participation.

Supervision *

I understand that parents or guardians are responsible for the supervision of their child(ren) at all times. Mercy Road Church does not provide supervision for children using the indoor playground.

Release and Hold Harmless *

I release, waive, discharge, and covenant not to sue Mercy Road Church, its employees, volunteers, agents, and representatives from any and all liability, claims, demands, or causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by my child(ren) while participating in playground activities.

Medical Treatment *

In the event of an emergency, I authorize Mercy Road Church personnel to obtain necessary medical treatment for my child(ren). I agree to be financially responsible for any resulting medical expenses.

Health Acknowledgment *

I affirm that all listed children are in good physical condition and free from any illness that could be aggravated by physical activity. My child(ren) have no known contagious conditions.

Facility Rules *

I agree that my child(ren) will follow all posted rules and verbal instructions from Mercy Road staff or volunteers. I understand that failure to comply may result in removal from the facility.

Media Release & Opt-Out

I give Mercy Road Church permission to take photos or videos of my child during PlayZone for use in church communications and social media. If you prefer your child not be photographed or recorded, please initial in the space below.

Acknowledgment and Signature *

I certify that I have read, understood, and agree to the terms of this waiver and release, and I voluntarily accept its contents. I am the parent or legal guardian of the above-named child(ren) and have the legal authority to execute this agreement.

Household members

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