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Waiver Form
Play, Laugh, and Grow at Desert Bloom!

Desert Bloom Play Café — Play Space Waiver &
Release Form
Child's Date of Birth
Month
Day
Year

Waiver and Release of Liability

Please read carefully and check the box below to agree.

I, the undersigned parent/legal guardian of the above-named child, hereby grant permission for my

child to participate in the play activities at Desert Bloom Play Café (“the Café”).

I acknowledge that play areas and activities involve inherent risks, including but not limited to

minor injuries such as cuts, bruises, or falls. I agree to assume all risks associated with my child’s

participation and release Desert Bloom Play Café, its owners, employees, and agents from any

liability for injuries or damages sustained during use of the play space.

I certify that my child is in good health and has no physical or medical conditions that would restrict

participation. I agree to supervise my child while on the premises and ensure compliance with all

Café rules, including wearing socks in the play area.

I understand that Desert Bloom Play Café reserves the right to refuse service or remove any child

who does not follow safety rules or whose behavior may endanger themselves or others.

● I have read, understand, and accept the terms of this waiver.

Optional: Emergency Contact Information

Download and Print the Waiver:

© 2025 by Desert Bloom Play Cafe. All rights reserved.

Designed by IHE

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