PERMISSION SLIP

ACKNOWLEDGEMENT OF RISK, WAIVER OF LIABILITY, MEDICAL AUTHORIZATION
As parent or legal guardian of _________________________, I voluntarily consent to the aforementioned person(s) participating in play at Kangaroo Kids Inflatable Party Center (High Hoppers Inc.). I accept all risks associated with that participation. I fully understand the risks involved while playing with other people on inflatable equipment as well as in the rest of the party facility. I acknowledge that these risks include, without limitation, the possibility of bodily injury, paralysis or death.
In consideration for allowing my child(ren) to use these facilities, I, on my own behalf and that of my child(ren) and our respective heirs, administrators, executors and successors, hereby forever release and covenant to indemnify and hold harmless any and all entities of High Hoppers Inc. dba Kangaroo Kids as mentioned above, their officers, directors, employees and other individuals associated with their operations, from all liability for any and all damages and injuries suffered by my child(ren) from participation in the aforesaid play including any time spent celebrating and having refreshments after the inflatable play session. Additionally, I hereby agree to individually provide for all possible future medical expenses which may be incurred by my child(ren) as a result of any injury sustained while participating at any facility of Kangaroo Kids or affiliates.
I have read and understand this Acknowledgement of Risk, Waiver of liability, and medical authorization, and I voluntarily affix my name in agreement.
Medical Comments:________________________________________________________
Participant Name:____________________ Participant Date of Birth:____________
Participant Name:____________________ Participant Date of Birth:____________
____________________________________ __________________________________
Parent/ Guardian Signature Date
____________________________________
Parent/ Guardian Printed Name
Address:____________________________ City, State ZIP:_____________________
Emergency Contact Number:___________ Email:_____________________________

KANGAROO KIDS INFLATABLE PARTY CENTER
1015 GRAND BLVD • DEER PARK, NY 11729 • (631) 871-8762