Concrete Safaris


JungleGym Race Registration Form
Last Name

First Name

Birth Date	// (mm/dd/yyyy)

Phone

Email



Which JungleGym will you race?	July 25th on E 106 St between Lexington and 3rd Avenues August 15th on E. 116 St between Lexington and 3rd Avenues Both events
WAIVER FOR CHILD RACERS & FACEPAINTING
This Agreement establishes the rights and liabilities regarding your child’s participation in JungleGym hosted by Concrete Safaris (Concrete Safaris and its directors, officers, employees, agents, successors and assigns defined as “CS”). By signing below, you represent that you have the legal authority to submit to this Agreement on behalf of the child registered for JungleGym and acknowledge that your child’s participation in JungleGym involves potential risks to your child and that you are voluntarily permitting your child to participate. In particular, you acknowledge that COVID-19 is extremely contagious and that even with the use of protective equipment, social distancing, and other protective measures your child may be exposed to or contract COVID-19 during JungleGym. In consideration for your child’s participation in JungleGym, including games, obstacles, face painting, and any other event-related activities, you and your child hereby release and hold harmless CS and NYC from all claims or losses related to your child’s participation in JungleGym (the “Release”). The Release is binding upon all of your heirs, executors, and representatives and upon CS’s and NYC's successors and assigns and is not assignable without the prior written consent of CS and NYC. You confirm that you have read this agreement and understand its terms, and have signed freely, voluntarily, and under no duress or threat of duress, that you are 18 years of age or older, and that you are mentally competent to enter into this Agreement. This Agreement is governed by the laws of the State of New York and is intended to be as broad and inclusive as is permitted by the laws of the State of New York.
PARENT/GUARDIAN INITIAL HERE *
DATE *

Neon CRM by Neon One

Timeout Warning

JungleGym Race Registration Form

WAIVER FOR CHILD RACERS & FACEPAINTING