Complete a waiver for myself
Complete a waiver for myself and children
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Adult Information

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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.

SMARTY SPROUTS KIDS’ CLUB WAIVER OF LIABILITY AND RELEASE FORM

 

I, for myself and my child/children desire to use the facilities at SMARTY SPROUTS KIDS’ CLUB (“SMARTY SPROUTS”) located at: 3100 WILDFLOWER DRIVE, SUITE 300, BRYAN TX 77802. This Assumption of Risk, Waiver, and Release of Liability covers all activities at SMARTY SPROUTS.

I understand that adult supervision of each child by that child’s parent or authorized caregiver is required at all times.

I understand that my agreement and completion of this waiver on the first visit will authorize the SMARTY SPROUTS KIDS’ CLUB to use it as a continuous waiver for my child’s/children’s ongoing participation in the activities or use it as a waiver executed for my other child/children. I hereby expressly authorize SMARTY SPROUTS KIDS’ CLUB to use this waiver as a multi-use waiver until I have expressed to change this in writing.

RISK FACTORS  I understand that the activities at SMARTY SPROUTS entail the risk of serious bodily injury. The risk of injuries includes (but is not limited to): minor injuries such as cuts and bruises and more serious injuries such as broken bones, dislocations, and muscle pulls. I and the participants named herein expressly and voluntarily assume all risks and full responsibility for any injury or loss resulting from activities at SMARTY SPROUTS. I am responsible for ensuring all participants will follow all rules of SMARTY SPROUTS and act in a safe and responsible manner. I will supervise all participants

ASSUMPTION OF RISK  I am choosing to use the facilities at SMARTY SPROUTS at my own risk. I understand and acknowledge that the activities which I or/and any minor children for which I am the Parent, legal guardian, or otherwise responsible or any heirs or personal representative are about to voluntarily engage in as a participant and/or volunteer bears certain know risks and unanticipated risk could result in injury, illness, disease or death, physical or mental, or damage to myself, or to spectators or third-parties. I assume full responsibility for all risks that may arise from using the facilities at SMARTY SPROUTS or from participating in activities at SMARTY SPROUTS. SMARTY SPROUTS activities involve many risks, including but not limited to the following: All play equipment and all things inside the Premises entail certain risks that simply cannot be eliminated without jeopardizing the essential qualities of the activity. Our play equipment exposes its participants to the usual risk of cuts and bruises. Other more serious risks exist as well. Participants often fall off equipment, sprain or break wrists and ankles, and can suffer more serious injuries as well. Traveling to and from one location raises the possibility of any manner of accidents. Coming down the slides can cause serious injury. Similar risks are also inherent in ball pit, play rooms and soft play structure, where children and adults can be injured. Also, injuries can be caused by coming into contact with other customers or persons at the facility. SMARTY SPROUTS has no control or is in no way liable for any injury resulting from other minors, parents, or guardians at the facility. In any event, if you or your child is injured, you or your child may require medical assistance, at your own expense. Furthermore, SMARTY SPROUTS employees, including managers and volunteers, have difficult jobs to perform. They seek safety, but they are not infallible. They might be unaware of a participant’s fitness or abilities. They may give incomplete warnings or instructions, and the equipment being used might become loose, out of adjustment, or malfunction. There is also a risk that SMARTY SPROUTS employees may be negligent in, among other things, monitoring and supervising use of its equipment and facilities and in the maintenance and repair of its equipment and facilities. I, the Parent or the Legal Guardian of my child, hereby understand and agree to accept the risk of bodily injury and/or property damage which the child or I may incur or cause a third party to incur as a result of our use of the Premises. WITH THIS UNDERSTANDING AND FOR THE CONSIDERATION OF ALLOWING THE CHILD ADMISSION TO AND USE OF THE PREMISES, THE UNDERSIGNED AGREES TO RELEASE, INDEMNIFY, DEFEND, AND HOLD HARMLESS SMARTY SPROUTS, ITS OFFICERS, AGENTS, ASSISTANTS AND EMPLOYEES, AND ALL OF THE PERSONS, FIRMS, ORGANIZATIONS, OR CORPORATIONS IN PRIVITY WITH THEM, WHETHER NAMED HEREIN OR NOT (THE “PARTIES RELEASED”) FROM AND AGAINST ANY AND ALL CLAIMS, CAUSES OF ACTION, INJURIES, SUITS, OR JUDGMENTS ARISING FROM, OR IN CONNECTION WITH THE CHILD’S PRESENCE AT SMARTY SPROUTS, REGARDLESS OF THE PARTIAL OR SOLE FAULT OR NEGLIGENCE OF THE PARTIES RELEASED. THE UNDERSIGNED AGREES TO THIS INDEMNIFICATION AND HOLD HARMLESS FOR MYSELF, MY SUCCESSORS, ASSIGNS, HEIRS, EXECUTORS AND ADMINISTRATORS, AND ANY OTHER PERSON OR ENTITY(IES) WHO/WHICH MAY HAVE A CLAIM BASED UPON THE CHILD’S PERSONAL INJURIES AND/OR PROPERTY DAMAGE, CLAIMS FOR CONSORTIUM BY ANYONE ALLEGING A RELATIONSHIP THAT WOULD GIVE RISE TO SUCH A CAUSE OF ACTION, ANY INDIVIDUAL CLAIMING A PARENTAL, CUSTODIAL, OR POSSESSORY RELATIONSHIP WITH THE CHILD, MEDICAL EXPENSES OR LIENS OF ANY HOSPITAL(S), MEDICARE, MEDICAID, HEALTH CARE PROVIDER, INSURANCE CARRIER (INCLUDING, BUT NOT LIMITED TO, LIFE, HEALTH, OR DISABILITY) PAYMENTS FOR DAMAGES TO OTHER PERSONS OR ENTITIES, FOR CONTRIBUTION OR INDEMNITY, COURT COSTS, ATTORNEYS’ FEES, OR OTHER EXPENSES OF LITIGATION, WHICH HAVE BEEN OR MAY BE AT ANY TIME IN THE FUTURE MADE AGAINST THE PARTIES RELEASED BECAUSE OF, OR DIRECTLY RESULTING FROM, INJURIES, DAMAGES, OR OTHER LOSSES SUSTAINED BY THE CHILD AS A RESULT OF ADMISSION TO AND USE OF THE PREMISES.

I have read and understand the information listed above and the risks associated with the admission to and use of the Premises. I understand that in the unlikely event my child is injured during the use of the Premises, SMARTY SPROUTS will not cover the medical costs, and that my personal accident or medical insurance will be required to cover expenses. In the event that my child sustains injury or illness while on the Premises, I hereby authorize any emergency first aid, medication, medical treatment or surgery deemed necessary by licensed medical personnel. I also give my permission for attending medical personnel to execute on my behalf my permission forms or other necessary medical documents and to act on my behalf if I am not immediately available to do so.

ACKNOWLEDGEMENT OF POLICIES AND PROCEDURES  I acknowledge that I have read, know, and agree to all of the policies and procedures relating to the use of the facilities at SMARTY SPROUTS I agree to comply with all rules, regulations, and policies at SMARTY SPROUTS. I understand SMARTY SPROUTS reserves the right to revoke or terminate my use of the facilities at SMARTY SPROUTS for any violation of rules, regulations, or policies.

RELEASE, INDEMNIFY AND DEFEND  I hereby release, waive, discharge, and hold harmless SMARTY SPROUTS and all employees past or present from any claims, suits, liabilities, judgments, costs and expenses for any property damage, loss or theft, personal injury or illness, death, or other loss arising from the use of SMARTY SPROUTS. I FURTHER AGREE, PROMISE AND COVENANT TO HOLD HARMLESS AND TO INDEMNIFY Releases, and all other persons or entities from all defense costs, including attorneys’ fees, or any other costs incurred in connection with claims for mental or bodily injury, wrongful death, or property damage that may be filed by me, my child, my heirs or my estate. Such indemnity and defense obligation shall further extend to any claim, loss, or lawsuit, which alleges that I or my child negligently or intentionally caused any injury, death or damage to any other third parties while on the Premises.

PAYMENT OF DAMAGES - I agree to pay for any and all damages to any property or equipment as a result of my or my family’s willful actions, neglect, or recklessness and agree to be held liable for all such costs associated with such damages.

REPRESENTATIVES I enter into this agreement for myself as well as for my heirs, assigns, and legal representatives.

WAIVER  I hereby waive any protections afforded by any statute or law in any jurisdiction whose purpose and/or effect is to provide that a general release shall not extend to claims, material or otherwise which the person giving the release does not know or suspect to exist at the time of executing the release. I am releasing unknown future claims.

INSURANCE  I understand that I am solely responsible for any medical, health, or personal injury costs relating to my use of SMARTY SPROUTS and its facilities. I understand that I am strongly encouraged to have a medical physical exam and purchase health insurance prior to my use the facilities at SMARTY SPROUTS.

ARBITRATION - All parties to this agreement agree to mediate, in good faith, any dispute or controversy arising out of, relating to, or in connection with the interpretation, the validity, construction, performance, breach, or termination of this agreement, prior to initiating arbitration or litigation based on the laws of the state of Texas. Prior to initiating any litigation, all parties agree that any dispute shall be settled by binding arbitration and accordance with the rules then in affect of the American Arbitration Association. The prevailing party in the event of arbitration or litigation shall be entitled to costs and reasonable attorney fees.

SEVERABILITY. If any provision or portion of this Release and Indemnity Agreement shall be held by a court of competent jurisdiction to be illegal, invalid, or unenforceable, the remaining provisions or portions shall remain in full force and effect.

COVID -19 ACKNOWLEDGEMENT - In light of the novel coronavirus (“COVID-19”) pandemic, I acknowledge and agree (on behalf of myself and all participants named herein) that: (1) SMARTY SPROUTS may institute any procedures or requirements it deems necessary or appropriate, and that SMARTY SPROUTS may revise its procedures and requirements at any time, to guard against transmission of COVID-19; (2) Neither I nor any named participant will enter the SMARTY SPROUTS premises if any of us: (a) has a suspected or confirmed cased of COVID-19; (b) experiences any symptoms of COVID-19, including fever, cough, or shortness of breath; (c) has been exposed to any person who has a suspected or confirmed case of COVID-19 within the past 14 days. (3) Six-foot physical distancing among participants at SMARTY SPROUTS is not always possible, due to the nature of activities at SMARTY SPROUTS; (4) I (hereinafter referred to as “I”, "You" or “the undersigned”) understand that the risk of becoming exposed to or infected by COVID-19 at SMARTY SPROUTS may result from the acts, omissions, or negligence of myself and others, including, but not limited to, SMARTY SPROUTS’ employees, volunteers, and program participants and their families; (5) By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that the named person(s) below and I may be exposed to or infected by COVID-19 by permanent disability, and death.  I sign this document on behalf of myself and the named person(s) below and hereby release, covenant not to sue, discharge, and hold harmless SMARTY SPROUTS, 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; (6) Smarty Sprouts Kids’ Club (SMARTY SPROUTS) has put in place preventative measures to reduce the spread of COVID-19, however, SMARTY SPROUTS cannot guarantee that you or the below-named persons will not become infected with COVID-19; (7) to the fullest extent allowed by law, to expressly and voluntarily assume all risks of contracting COVID-19 due to participation in activities at SMARTY SPROUTS.

Use OF PHOTOGRAPHY AND/OR VIDEOS - SMARTY SPROUTS KIDS’ CLUB may use any photograph/video taken at the facility without the expressed written permission of those included within the photograph/video. SMARTY SPROUTS KIDS’ CLUB may use the photograph/video in publications or other media material produced, used or contracted by SMARTY SPROUTS KIDS’ CLUB including but not limited to: invitations, magazines, newspapers, brochures, television, social media, websites, etc. A person attending SMARTY SPROUTS KIDS’ CLUB event who does not wish to have their image recorded should make the wishes known to the SMARTY SPROUTS KIDS’ CLUB. By participating in SMARTY SPROUTS KIDS’ CLUB or by failing to notify the SMARTY SPROUTS KIDS’ CLUB in writing, you desire to not have your photograph used by SMARTY SPROUTS KIDS’ CLUB, you are agreeing to release, defend, hold harmless and indemnify SMARTY SPROUTS KIDS’ CLUB from any and all claims involving the use of your picture.

I have read and fully understand this Assumption of Risk, Waiver, and Release from Liability and understand that it relates to surrendering and releasing valuable legal rights. I do so freely and voluntarily on behalf of myself and any minor child/children for which I am the parent, legal guardian, or otherwise responsible for, named below:

Consent and Release on Behalf of Minor by Parent/Legal Guardian

I am the parent or legal guardian of the above named minor. I have read and understand this Assumption of Risk, Waiver and Release from Liability form and understand that it relates to surrendering valuable legal rights of the minor and myself. I agree to be bound by all the terms of the Assumption of Risk, Waiver, and Release from Liability. I give my consent for participation at SMARTY SPROUTS.

 


By signing this waiver, I agree that all information is complete and accurate.