The Pump It Up Permission Slip form serves as a comprehensive agreement designed to ensure the safety and accountability of all participants engaging in activities at Pump It Up facilities. This document outlines the responsibilities and understandings between the parties involved, primarily focusing on the participants, the guardians or parents, and the facility owners. The form starts by verifying that the signatory has the authority to act on behalf of the participant(s), listing their names and dates of birth for identification. It then highlights the inherent risks associated with the play activities, such as injuries ranging from minor scrapes to more severe outcomes. Importantly, the form acknowledges that these risks include not only the direct participation in activities but also those that may arise from the actions of other participants. For safety, the agreement requires adherence to all Pump It Up rules and the guidance provided by its staff. The form further requires the signatory to waive rights to hold the facility responsible for any injuries or damages suffered, extending to agreement to cover any legal costs the facility might incur defending such claims. To conclude, the signatory affirms their understanding of the terms and affirm their capability to enter this agreement freely, providing essential contact information and consenting to receive communication from the facility, including promotional messages. This permission slip ensures all parties are informed, consent to the terms of participation, and understand their roles in creating a safe, enjoyable environment.
| Question | Answer |
|---|---|
| Form Name | Pump It Up Permission Slip Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | pump it up perrmision slip pdf, pump it up waiver form, pump it up age limit, permissssion slip form |
Pump It Up®
Waiver, Release, Hold Harmless, and Indemnification Agreement
Rev. 10.001
As Consideration for being allowed to enter the play area and/or Participate in any party and/or program at Pump It Up 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:
1.I represent that I am the parent or legal guardian of the Participant(s) named below or I have obtained permission from the parent/legal guardian of the Participant(s) named below to execute this agreement on their behalf.
Participant Name |
Date of Birth |
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Participant Name |
Date of Birth |
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Participant Name |
Date of Birth |
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Participant Name |
Date of Birth |
2.I acknowledge and understand that there are risks associated with participation in Pump It Up activities and the use of the play area and inflatable equipment including but not limited to: contusions, fractures, scrapes, cuts, bumps, paralysis, or death.
3.I, for myself and the Participant(s) named, willingly assume the risks associated with participation and accept that there are also risks that may arise due to OTHER PARTICIPANTS which I also willingly assume.
4.I agree that the Participant(s) named, and I shall comply with all stated and customary terms, posted safety signs, rules, and verbal instructions as conditions for participation in any party and/or program at Pump It Up.
5.I, for myself, the Participant(s) named, our heirs, assigns, representatives, and next of kin agree to hold harmless and indemnify the independent owner of this Pump It Up facility, PIU Holdings, LLC, their predecessors, parent, subsidiaries and affiliates, officers, and employees from any and all injuries, liabilities or damages from participation.
6.I additionally agree to indemnify the independent owner of this Pump It Up facility, PIU Holdings, LLC, their predecessors, parent, subsidiaries and affiliates, officers, and employees for any defense cost or expense arising from any and all claims, injuries, liabilities or damages arising from participation.
7.I am of physical ability to participate and am legally competent to understand and complete this agreement. I hereby execute this agreement without coercion.
Parent / Guardian Name (please print): _____________________________________________________
Parent / Guardian Signature: __________________________________________DATE:_______________
Address: _____________________________________________________________________________
City: ____________________________________________ ST: __________ Zip: ________________
Emergency Contact number: ( ) _______________________ or ( ) ______________________
By providing your