Yearly Waiver and Release Form
I voluntarily agree to comply with all rules and conditions of PB & J.s. If
I observe any unsafe condition, I will bring it to the attention of the staff
of PB & J.s.
I understand that there are inherent risks involved in using inflatable
equipment and other play equipment, including all equipment located at
PB & J.s. These risks include but are not limited to sprains, broken
bones, joint or back injury, and death. I represent to the best of my
knowledge that I and/or the participant is physically sound, and does
not have any medical conditions that would be aggravated by using play
equipment.
I assert that my participation is voluntary and that I knowingly assume
all such risks. Therefore, I assume full responsibility for using the play
equipment located at PB & J.s and I voluntarily and freely choose to
assume all such risks and dangers, including the risk of injury or death
that may be associated with, or result from, using the play equipment,
even if caused by the negligence of PB & J.s or its staff or other guests.
I, for myself, my heirs, personal representatives or assigns, do hereby
release, waive, discharge, and covenant not to sue PB & J.s Development,
LLC and/or PB & J.s Development, LLC d/b/a PB & J.s and any of their
affiliates, officers, members, agents, employees, other guests or
sponsoring agencies from liability from any and all claims resulting in
personal injury, accidents, illnesses, death, or property loss.
I give my permission to PB & J.s and its staff to obtain on my behalf any
emergency medical treatment. In case of sickness, accident, or injury,
PB & J.s and its staff has my express permission to secure, at my
expense, such medical treatment as is deemed necessary in the sole
discretion of PB & J.s and its staff.
By my signature below, I acknowledge that I have read and agree to all
statements contained in this document.  I acknowledge and agree that the waiver 
and release described in this document will be kept on file at PB & J’s and applies 
to me and or the participant(s) listed below for the time period between the date that 
I sign this document and December 31, 2009.  Specifically, I acknowledge and 
agree that this waiver and release applies each time I and/or the participant(s) 
visit PB & J’s during the applicable time period.

Participant.s Name (print): ______________________________
Participant.s Date of Birth: ______________________________
Participant.s parent/guardian (name): ______________________________
Participant.s parent/guardian (signature): ______________________________
Date: __________________ All dates through and including Dec 31, 2009
Emergency Contact & Phone Number: ______________________________