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

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( Age must be at least 18 years old )

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Waiver and Release of Liability

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.



In consideration of the risk of injury while participating in Kidsville Playground's indoor playground (the "Activity"), and as consideration for the right to participate in the Activity, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter into this Waiver and Release of Liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the Activity, and do hereby release and forever discharge Kidsville Playground, located at 3664 Pulaski Hwy, Cornersville, Tennessee 37047, its owners, affiliates, agents, attorneys, employees, volunteers, heirs, and other representatives, for any injury that I may suffer as a direct result of my participation in the aforementioned Activity.


I am voluntarily participating in the Activity and I am participating in the activity entirely at my own risk.  I am aware of the risks associated with participating in this activity, which may include, but are not limited to, physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss, and death.  I understand that these injuries or outcomes may arise from my own or others’ negligence or the condition of the Activity location.  Nonetheless, I assume all related risks, both known or unknown to me, of my participation in this Activity.


I agree to indemnify and hold harmless Kidsville Playground against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney's fees and any related costs.  If Kidsville Playground incurs any of these types of expenses, I agree to reimburse Kidsville Playground.


I acknowledge that Kidsville Playground and its owners, affiliates, agents, attorneys, employees, volunteers, heirs, and other representatives are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of Kidsville Playground.


I acknowledge that I have carefully read this Waiver and Release of Liability and fully understand that it is a release of liability.  I expressly agree to release and discharge Kidsville Playground and all of its owners, affiliates, agents, attorneys, employees, volunteers, heirs, and other representatives, for any and all claims or causes of action and I agree to voluntarily give up or waive any right that I otherwise have to bring a legal action against Kidsville Playground for personal injury of property damage.


I acknowledge that I am familiar with and will abide by the rules related to participation in the Activity, including adherence to all height and weight restrictions.


In the event that I should require medical care or treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance.


In the event that any damage to equipment or facilities occurs as a result of my or my family's willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any actions of neglect or recklessness. 


In the event that the participant is under the age of 18, then this Waiver and Release of Liability must be signed by a parent or guardian.  I, the undersigned participant or parent/guardian, affirm that I am of the age of 18 years or older, and that I am freely signing this agreement. I certify that I have read this agreement, that I fully understand its content and that this release cannot be modified orally. I am aware that this is a release of liability and that I am signing it of my own free will.

I acknowledge I have read and understand this waiver and certify that all personal information is correct.
By signing this waiver, I agree that all information is complete and accurate.