Kids City LLC General Liabili...

Kids City LLC General Liability Release Form

CONFIDENTIAL

Employee Full Name

Phone

Gender

Male

Female

Birthdate (MM/DD/YY)

PPE (Personal Protective equipment) provided by company:

EVA non- slip foam slipper or Non-slip rubber grip socks  Nitrile glove

Use of any Photography and/or Videos:

The Playground may use any photos/videos taken at The Playground, without the expressed written and/or oral permission of those included within the photo/video. The Playground may use the photo/video in any form of advertisement or other media material produced including but not limited to: fliers, social media, website, fliers, etc. You and your heirs are agreeing to release, defend, hold harmless and indemnify The Playground from any and all claims involving the use of your photos/videos.

Assumption of Risk:

I know that physical activity is potentially hazardous and that I should not engage in any activity unless I am medically/physically able. I certify that I am in good health, and have no reason to believe I am not physically capable of participating in the event. (Remember, it’s always advisable to check with your physician).    I completely understand and realize that NOT using the company provided PPE in the above mentioned could be dangerous or hazardous to me.

Use of equipment during work hours and Assumption of Risk:

Employees are not required and will not be forced to try any playground equipment during work hours.  Kids City is not liable for employees’ trying equipment at their own will during work hours.   Risk factors: I understand and acknowledge that the use of the facilities at The Playground involves risks including, but not limited to the following: bodily injury including but not limited to permanent disability, paralysis, and death.  These risks may result from a variety of circumstances including the misuse of equipment or facilities.   Assumption of Risk: I am choosing to use the facilities at The Playground at my own risk.  I understand and acknowledge that the activities which I am about to voluntary engage in as an employe bears certain known risks and unanticipated risk could result in injury, death, illness or disease, physical or mental, or damage to myself, or to spectators or third-parties.  I assume full responsibility for all risks that may arise from using the facilities at The Playground or from participating in activities at The Playground.   Release, Indemnify, and Defend: I hereby release, waive, discharge, and hold harmless The Playground and all employees past or present form any claims, suits, liabilities, judgments, costs and expenses for any property damage, loss or theft, personal injury or illness, death or other loss arising from use of The Playground.

By signing below :

I agree to the fact that NOT  using company provided foot wear (PPE) can cause harm or injury to me. I release Kids City LLC named above from all liability, cost and damages which could arise from NOT using company provided safety gear in the above mentioned SAFETY GEAR. I agree to accept financial responsibility for the cost related to this emergency treatment and give my confirmation of the same by signing this document.

Signature

Date Signed

Your general liability release form will be filed in your confidential personnel record and will be retained for the duration of your employment plus 30 years.

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