WAIVER

Waiver, Release, Hold Harmless and Indemnification Agreement

As Consideration for being allowed to enter the play area and/or Participate in any party and/or program at Kidzercise 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 attained permission from the parent/legal guardian of the Participant(s) named below to execute this agreement on their behalf.

Participant Name

DOB

2. I acknowledge and understand that there are risks associated with participation in Kidzercise activities and the use of the equipment including but not limited to contusion, fractures, scrapes, cuts, bumps or death. 3. I, for myself and the Participant(s) names, willingly assume the risk 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 Participants(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 Kidzercise. 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 Kidzercise Sneaky Fitness, LLC and their predecessors, parent, subsidiaries and affiliates, officers, employees from any and all injuries liabilities or damages from participation. 6. I additionally agree to indemnify the independent owner of Kidzercise LLC, their predecessors, parents, 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 agree that the Participant(s) named are of physical ability to participate. I am legally competent to understand and complete this agreement. I hereby execute this agreement without coercion.

Parent / Guardian First Name

Parent / Guardian Last Name

Signature

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Emergency Contact

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