Agreement to Use Facilities and Services Provided and Waiver of Liability
As Consideration for being allowed to enter the play area/or participate in any party and /or program at CHIKI TOWN the undersigned, on his or her behalf, and on the behalf of the Participant(s) identified below, acknowledges, appreciates, understands, and agrees to the following :
• I understand that inherent risk of injury or illness, though minimal, does exist. • I and the children have no illness or injury that may affect the safe enjoyment of CHIKI TOWN by us or other guests. • I, for myself and the children, knowingly and freely assume full responsibility for my and the children’s participation at CHIKI TOWN and freely assume all risks, both known and unknown, even if arising or resulting from negligence of CHIKI TOWN staff or others. • I and the children willingly agree to comply with the stated terms and conditions for participation and to obey the directions of and requests of CHIKI TOWN staff. • I, for myself and the children, agree to the following safety rules:
- No Bare Feet. Socks are Mandatory and Children remain the responsibility of their accompanying adult at all times
- An attending adult must remain on the premises at all times for children all ages.
- No gum, food or drink in the play areas, designated areas only
- No climbing the slides or No climbing on the outside of the structure
- No hooded sweaters or clothing with drawstrings that could get caught
- Please report any inappropriate behavior to a CHKI TOWN staff member
- CHIKI TOWN reserves the right to refuse admission and request any person to leave the premises
- CHIKI TOWN is not responsible for any lost or stolen items

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.
I further acknowledge that CHIKI TOWN Jo has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.
I further acknowledge that CHIKI TOWN cannot guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to staff, and other clients and their families.  I attest that:

- I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.
- I have not traveled internationally within the last 14 days.
- I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.
- I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities.
- I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.
• I have ensured the children are aware of the above safety rules. • I, for myself, the children and on behalf of my and their heirs, assigns, personal representatives and next Of kin, hereby waive, release and discharge CHIKI TOWN and its directors, officers, agents, Employees, owners and representatives (collectively ‘CHIKI TOWN’) with respect to any and all losses, Damages, injuries, expenses and claims, including without limitation suffered or incurred as a result of the children using CHIKI TOWN, due to any cause whatsoever, for personal injury, death or loss or damage to person or property, even if arising from the negligence of CHIKI TOWN or otherwise and hereby agree to indemnify and hold harmless CHIKI TOWN from and against any liability, losses, claims and damages resulting from the children using CHIKI TOWN. • I have read this release and waiver of liability agreement, fully understand its terms, understand that I have given up substantial rights for myself and the children by signing it, and sign it freely and voluntarily, without inducement.
Parent / Guardian Signature *
PHOTO RELEASE - I grant permission for my child(ren) to be photographed, or their images recorded for print or electronic use in promoting Chiki Town. I understand that it is my responsibility to update this form in the event that I no longer wish to authorize the above uses. I agree that this form will remain in effect during the term of the child’s enrollment. I understand that there will be no payment for me or my child’s participation in this release. *
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