KIDS CITY HAWAII WAIVER AND RELEASE FOR Assumption of Risk, Waiver and Release from Liability

This waiver is good until 12/31/2020 once you sign up.

Please sign up for the new waiver if it is expired.

We will store your waiver form record until 12/31/2020. Please ask the staff for your record.

You agree on using this facility for the whole year of 2020 once  you sign up this form.

I (Parent or Guardian) desire to use the facilities at KIDS CITY, LLC. (“The Playground”) located at: 91-5431 Kapolei Pkwy Suite 1117, Kapolei, HI 96707. This Assumption of Risk, Waiver, and Release of Liability covers all activities at the Playground. 


Child name Full name is required only if child has different last name
Full name is required only if child has different last name from the guardian
No Dash ( - ) or Slash ( / ) needed Examples: 01122018 MMDDYEAR


I agree to the following:

1. 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. 


2. Assumption of Risk‐ I am choosing to use the facilities at The Playground at my own risk. I understand that child supervision is the responsibility of the child’s parent or authorized guardian at all times. I understand and acknowledge that the activities which I am or/and (any minor children for which I am the Parent, legal guardian, or otherwise responsible, any heirs personal representative) about to voluntarily engage in as a participant and/or volunteer bears certain know 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. 


3. Acknowledgement of Policies and Procedures‐ I acknowledge that I have read, know, and agree to all of the policies and procedures relating to the use of the facilities at The Playground. I agree to comply with all rules, regulations, and policies at The Playground. I understand The Playground reserves the right to revoke or terminate my use of the facilities at The Playground for any violation of rules, regulations, or policies.

4. Release, Indemnify, and Defend‐ I hereby release, waive, discharge, and hold harmless The Playground and all employees past or present from 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 the use of The Playground. 


5. Waiver‐ I hereby waive any protections afforded by any statute or law in any jurisdiction whose purpose and/or effect is to provide that a general release shall not extend to claims, material or otherwise which the person giving the release does not know or suspect to exist at the time of executing the release. I am releasing unknown future claims.

6. Payment for damages‐ I agree to pay for any and all damages to any property or equipment as a result of my or my heirs willful actions, neglect, or recklessness and agree to be held liable for all such costs associated with such damages.

7. Representatives‐ I enter into this agreement for myself as well as for my heirs, assigns, and legal representatives.

8. Insurance‐ I understand that I am solely responsible for any medical, health, or personal injury costs relating to my use as well as for my heirs of The Playground and its facilities.

9. Arbitration- All parties to this agreement agree to mediate, in good faith, any dispute prior to initiating arbitration or litigation based on the laws of the state of Hawaii. The prevailing party in the event of arbitration or litigation shall be entitled to costs and reasonable attorney fees.

10. 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.


I have read and fully understand this Assumption of Risk, Waiver, and Release from Liability and understand that it relates to surrendering and releasing valuable legal rights. I do so freely and voluntarily on behalf of myself and any minor child/children for which I am the parent, legal guardian, or otherwise responsible for, named below:

Electronic Signature and Acknowledgement
Enter the date and your full name to acknowledge your electronic signature of this document.
Your Electronic Signature*