CHILDREN’S PLAYROOM PARTICIPATION AGREEMENT & LIABILITY WAIVER

KIDS' PLAYROOM PARTICIPATION AGREEMENT & LIABILITY WAIVER

Age Eligibility: 3-12 years old (*3-4 years-olds MUST be accompanied by a babysitter or an older sibling of at least 7 years old)
Burning Tree Country Club (BTCC) requires the following Liability Release form to be signed by parents before children are permitted to use the Children’s Playroom for the first time.

The Parent/Member Understands that:

I have read the rules of the Playroom and will abide by them in full. I have explained the rules to my child(ren) and agree that the staff of BTCC may deny further participation to any person who violates the rules. I am responsible for having my child(ren) follow the rules and safety procedures mentioned in the Playroom Policies by BTCC in order to protect the equipment and provide a safe environment for my child(ren) while utilizing the Playroom facilities. I agree to indemnify, defend and save harmless BTCC, its governors, officers, agents, committees, employees and members from and against all claims, suits, judgments liabilities and expenses, including attorney’s fees, arising out of or relating to, participation by my child(ren) in the BTCC Playroom facilities.

By signing the form below, I forfeit all rights to bring a suit against BTCC for any reason.
Name*

First NameLast NameMember #
Email*
example@example.com
Primary Contact - Cell Phone *
Please enter a valid phone number.
Secondary (Emergency) Contact*

First NameLast NameRelation
Secondary (Emergency) Contact - Cell Phone *
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How many children are you completing this waiver for? Number*

Please provide the following information regarding your child(ren); this form is only for children ages 3-12:*

	Name / Nickname	Age	Independent in the Bathroom? (Requires no supervision) Yes / No	Independent in BTCC Clubhouse navigation? (Requires no supervision) Yes / No	Pictures ok? Yes / No	Notes (anything we should be aware of)
1.
2.
3.
4.
5.

By signing the lines below, I assume responsibility for my child(ren) and having thoroughly discussed the Playroom Policies with them. My child(ren) understands the responsibilities accompanied with using the Playroom facilities.
Parent Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

KIDS' PLAYROOM PARTICIPATION AGREEMENT & LIABILITY WAIVER