Complete a waiver for myself
Complete a waiver for myself and children
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Adult Information

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( Age must be at least 18 years old )

Contact Information

Liability waiver

Please read the waiver below and fill out the required fields found in the following form sections. All liability language from the waiver will apply to all persons listed below.

I, and as parent or legal guardian of the child (or children) whose name is set forth below (each referred to as a “Participant” and collectively referred to herein as the “Participants”) and in consideration of the Participants being permitted to participate in the Activities (as defined below) conducted by Nana's Wonderland Inc., located at 45-07 248th St. Little Neck, NY 11362 (“Nana's Wonderland”) agree as follows:

  1. Activities – Activities shall be defined as the various activities and services offered to Participants by Nana's Wonderland, an indoor playground and café.
  2. I understand that the employees of Nana's Wonderland are not responsible for Participants who utilize the space and it is the responsibility of the undersigned individual to supervise any minors they bring into the facility.
  3. I, and the children under my care, understand and agree to the safety rules and play guidelines as outlined on I acknowledge that these rules and guidelines may change and that I have read and am familiar with them prior to entering the play space and making use of the facility.
  4. COVID-19 WARNING. An inherent risk of exposure to COVID-19 exists in any public place where people are present. COVID-19 is an extremely contagious disease that can lead to severe illness and death. According to the Centers for Disease Control and Prevention, senior citizens and guests with underlying medical conditions are extremely vulnerable.


  1. ASSUMPTION OF RISK – In addition to the inherent risk of exposure to COVID-19, I also understand that the Activities entail the risk of severe bodily injury to the Participants. Injuries that could result may vary, but may include (a) minor injuries such as scratches, bruises and sprains; (b) major injuries such as eye injury or loss of sight, joint or back injuries and concussions; and (c) catastrophic injuries, including paralysis and even death.

I understand that, Nana's Wonderland cannot eliminate all risks or guarantee the safety of the Participants while Participants participate in the Activities. I have made my own investigation of these risks, understand these risks, and assume them knowingly and willingly on behalf of myself and my minor Participant child.  Notwithstanding these risks and other hazards that may be foreseeable but not specifically identified herein, I, for myself and any minor Participant child, and our respective heirs, personal representatives and assigns, understand, acknowledge, and expressly and voluntarily assume all risks and full responsibility for any sickness or injury arising out of or related to the Activities.

  1. RELEASE, DISCHARGE & AGREEMENT NOT TO SUE – I, for myself and any minor Participant child and our respective heirs, personal representatives and assigns, do hereby release, discharge and agree not to sue Nana's Wonderland or its managers, members, employees and/or other agents, for any sickness, injury to or death of any Participant arising, directly or indirectly, from participation in the Activities. This release, discharge and covenant not to sue shall relate to any and all claims or legal rights now existing or arising in the future, including claims and legal rights arising out of any negligence of Nana's Wonderland and/or its managers, members, employees and/or other agents and any other breach of a legal duty arising out of common law, statute, contract or otherwise.
  2. Indemnification And Hold Harmless – I agree to indemnify Nana's Wonderland and hold Nana's Wonderland harmless from, without limitation, any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees and costs, incurred due to claims brought by any party as a result of or arising out of my or my minor Participant child’s involvement in the Activities and agree to reimburse Nana's Wonderland for any such costs, expenses and fees as they are incurred.
  3. Security Cameras. I understand that security cameras installed around and within Nana's Wonderland's facility are for the safety of all participants and may be referenced should any incidents or injury occur.
  4. Photo Release. I grant Nana's Wonderland permission to use any photographs, video, or sound bites obtained of me or any minor Participant child at Nana's Wonderland’s facility for any legal use including but not limited to: publicity, advertisement and web content. I understand that no royalty or other compensation shall be payable to me or the minor Participant by reason of such use.
  5. Parent or Legal Guardian Certification and Consent – I hereby certify that I am the parent or legal guardian of the minor Participant children whose name(s) appear below, and I have authority to waive rights on behalf of the minor Participant(s). I have read and I understand all of the provisions of this document and the risks of the Activities. I understand that the Activities could cause injury and even death. I acknowledge that I have read and understand the terms of this document and I am freely and voluntarily signing this document.  This Participation Agreement, Liability Waiver, and Hold Harmless Agreement has no expiration date.

By signing this waiver, I agree that all information is complete and accurate.