ASSUMPTION OF RISK, RELEASE AND WAIVER OF LIABILITY, INDEMNITY AGREEMENT (“WAIVER”) In consideration of being permitted to enter and use the facilities, play area, programs, services and equipment at Jumping Beans Indoor Playspace & Café LLC (“Jumping Beans”) located at 2222 152nd Avenue NE, Redmond, WA 98052 (“Premises”), the undersigned representative, on behalf of himself or herself and the participants identified below (the “Participants” and each a “Participant”) acknowledges and agrees to the following: 1. I represent that I am the parent or legal guardian of the Participants named below or I have obtained permission from the parent or legal guardian of the Participants named below to execute this agreement on their behalf. I agree that the Participants named, and I shall comply with all stated and customary terms, rules, and instructions of Jumping Beans as a condition of the entry and use of the facilities, play area, programs and services at the Premises. 2. I acknowledge and understand that there are known and unknown risks associated with the entry and use of the facilities, play area, programs and services at the Premises. I, for myself and the Participants named herein, knowingly and willingly assume any and all known and unknown risks associated with the entry and use of the facilities, play area, programs and services at the Premises which may or may not be expressly stated herein. 3. USE OF THE JUMPING BEANS’ FACILITIES, PROGRAMS, SERVICES AND EQUIPMENT IS AT THE UNDERSIGNED AND EACH PARTICIPANT’S SOLE RISK. THE PREMISES ARE PROVIDED ON AN “AS IS” AND “AS AVAILABLE” BASIS. THE UNDERSIGNED REPRESENTS THAT IT HAS INSPECTED THE JUMPING BEANS’ PLAY AREA, FACILITIES, PROGRAMS AND SERVICES AND FINDS AND ACCEPTS THEM AS BEING SAFE AND REASONABLY SUITED FOR ITSELF AND THE PARTICIPANTS. JUMPING BEANS EXPRESSLY DISCLAIMS ALL WARRANTIES OF ANY KIND, WHETHER EXPRESS OR IMPLIED. THE UNDERSIGNED ON HIS OR HER BEHALF AND ON BEHALF OF THE PARTICIPANTS ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE WHILE IN, ABOUT OR ON THE JUMPING BEANS’ PREMISES OR USING THE JUMPING BEANS’ PLAY AREA, FACILITIES, SERVICES OR EQUIPMENT. THE UNDERSIGNED, ON HIS OR HER BEHALF AND ON BEHALF OF THE PARTICIPANTS, HEREBY WAIVE AND RELEASE ANY AND ALL LOSSES, LIABILITIES, DAMAGES OR CLAIMS AGAINST JUMPING BEANS, ITS MEMBERS, MANAGERS, EMPLOYEES, AND AGENTS (THE “RELEASED PARTIES” AND EACH A “RELEASED PARTY”) ON ACCOUNT OF ANY INJURY TO PERSON OR PROPERTY OR DEATH OF THE UNDERSIGNED AND/OR THE PARTICIPANTS, WHETHER CAUSED BY NEGLIGENCE OR GROSS NEGLIGENCE OF THE RELEASED PARTIES WHILE THE UNDERSIGNED AND/OR PARTICIPANTS ARE ABOUT OR ON THE JUMPING BEANS PREMISES OR USING THE JUMPING BEANS’ PLAY AREA OR FACILITIES. THIS RELEASE AND WAIVER IS INTENDED TO BE AS BROAD AND INCLUSIVE AS PERMITTED BY THE LAWS OF THE STATE OF WASHINGTON AND THAT IF ANY PORTION HEREOF IS HELD INVALID, IT IS AGREED THAT ANY REMAINING PORTIONS SHALL REMAIN IN FULL FORCE AND EFFECT. 4. THE UNDERSIGNED AGREES TO INDEMNIFY AND HOLD HARMLESS EACH OF THE RELEASED PARTIES FROM ANY AND ALL LOSS, LIABILITY, OR DAMAGE INCURRED AS A RESULT OF HIS OR HER AND/OR A PARTICIPANT’S INJURY TO PERSON OR PROPERTY OR DEATH IN, ABOUT OR ON JUMPING BEANS’ PREMISES OR USE OF JUMPING BEANS’ PLAY AREA, FACILITIES, SERVICES OR EQUIPMENT WHETHER CAUSED BY THE NEGLIGENCE OR GROSS NEGLIGENCE OF A RELEASED PARTY. 5. THE UNDERSIGNED HAS READ AND KNOWINGLY AND VOLUNTARILY SIGNS THIS ASSUMPTION OF RISK, RELEASE AND WAIVER OF LIABILITY, INDEMNITY AGREEMENT AND ACKNOWLEDGES, UNDERSTANDS AND AGREES TO SUCH TERMS. _________________________________________________________________________________________________________________________ ADULT/PARENT/GUARDIAN Adult/Parent/Guardians Name (required) Adult/Parents/Guardians Email (required) Adult/Parents/Guardians Phone (required) Zip Code (required) Emergency Contact Name Emergency Contact Phone _________________________________________________________________________________________________________________________ PARTICIPANTS Participant (Child) Name (required) Participant Birth Date (required) (Format: YYYY-MM-DD example: 2012-01-10) 2nd Participant Name Participant Birth Date 3rd Participant Name Participant Birth Date 4th Participant Name Participant Birth Date _________________________________________________________________________________________________________________________ Hereby I certify that I am the adult parent or guardian of the child. I agree, personally and on behalf of the minor child named above, to assume all the risks and responsibilities surrounding my minor child’s use of Jumping Beans indoor play space. To the fullest extent allowed by law, I hold harmless and agree to indemnify Jumping Beans Indoor Playspace & Cafe LLC., its officers, directors, faculty, staff, volunteers, employees and agents, from and against any present or future claim, cause of action, loss or liability for injury to person or property, which said minor child may suffer or for which said minor child may be liable to any other person, related to said minor child’s participation in recreational activities at Jumping Beans, resulting from any cause whatsoever, and regardless of fault. I am at least eighteen years of age and have carefully read and freely signed this Liability Waiver and Release Form. I understand and agree that no oral or written representations can or will alter the contents of this document. I agree that this agreement shall be governed by the laws of the Commonwealth of the Washington State. PLEASE CLICK THE SUBMIT BUTTON ONLY ONCE! AND WAIT TIL YOU SEE THE CONFIRMATION PAGE. THANKS!