Jump On In Waiver And Electronic Waiver Sign-Up Sheet printable pdf download

This form must be completed and returned immediately upon registration. Please return via fax at 978-664-8061, email to

ssturdevant@northreadingma.gov, drop off at Recreation Office or at Summerscape Program.

Jump On In Waiver and Electronic Waiver Sign-up Sheet

Parent/Guardian Info: (

* Indicates Required Fields)

I am a Parent or Legal Guardian. Please enter the information below.

Parent’s First Name*

Parent’s Last Name*

Email Address*

Addr (req’d)*

Street*: ______________________________________________________________________

City*: _____________________________State*:____________________Zip*:_____________

Phone (req’d)*

Ph:_________________________________

Child 1:

Child 2:

First*

Last*

Birthdate*

Waiver:

In consideration of being allowed to enter into the play area and/or participate in any parties, classes or programs at the Jump On In

location, I, on my own behalf and on behalf of the minor(s) identified above, acknowledge, appreciate and agree that: I, as the

parent/legal guardian, or adult entrusted to care, assume full responsibility for all participants listed above. I willingly agree to

comply with the stated and customary terms, rules and conditions for participation. I recognize that the risk of possible injury,

including but not limited to the potential for paralysis, death, emotional distress, monetary loss, or other damage to myself, or the

and the above listed participants under my care, to property, or to third parties can occur in activities involving height or motion,

including participation in and/or use of Jump On In parties, classes, programs and equipment. While particular rules, equipment and

personal discipline reduce the risk, the risk does exist; and I knowingly and freely assume all risks to myself and the above

participants, both known and unknown, even if arising from the negligence of other participants. Being fully aware of these dangers,

I voluntarily consent to myself, the above listed minor(s) in my care participating in and using the Jump On In equipment, parties,

classes and programs.

I certify that the participant(s) named above is(are) of physical ability to safely participate in any of the facility's activities without

risk of injury to him/herself or other participants. In addition, if I observe any hazard, I will bring it to the attention of the nearest

Jump On In representative immediately. Further, I agree to assume liability for all medical costs, attorney fees, and all other

damages resulting from injury to myself and the above participants; and I, for myself and on behalf of my heirs, assigns, personal

representatives and next of kin, hereby hold harmless Jump On. In, Inc., JOI Franchising, LLC, any Jump On In franchisee and their

officers, agents, employees, other participants, and sponsoring agencies (“JOI Party” or “JOI Parties”) with respect to any and all

injury, disability, death, or loss or damage to person or property to the fullest extent of the law; and by signing or clicking Submit for

my children, for all participants in my care and/or my spouse.

I also agree to the above conditions, should I decide to participate. I understand that this waiver will be valid and in force for a

period of two years from today’s date. I agree that any dispute will be settled by arbitration. In the event that I file an arbitration

against any of the JOI Parties, I agree to solely do so in the state in which the JOI Party is located and I further agree that the

substantive law of the state in which the JOI Party is located shall apply in that action without regard to conflict of the law rules in

that state. I agree that if any portion of this waiver is found to be void or unenforceable, the remaining portions shall remain in full

force and effect.

By signing this document, I acknowledge that if anyone is hurt or property is damaged during my or my participant’s participation in

the programs or parties at Jump On In, I may be found to have waived my or the minor participant’s right to maintain a lawsuit

against the JOI Parties on the basis of any claim from which I have released them herein. I have had sufficient opportunity to read

this entire document. I have read and understood it, and I agree to be bound by its terms.

______________________________________________________________________

_____________________

Decline

Parent/Guardian Signature:

Date:

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Jump On In Waiver And Electronic Waiver Sign-Up Sheet

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