Kiddie Academy of Cupertino Events

Emergency Contact and Liability Release

Thu, Jan 29, 2026 - Ongoing

KIDDIE ACADEMY OF CUPERTINO

Kid(s)

*First name

*Last name

*Dob (mm/dd/yyyy)

*T-shirt

Medical info (please list all medicines, allergies, etc)

Parent / Guardian Emergency Contact

*First name

*Last name

*Email

*Mobile phone

*Address

*City

*State

*Zip code

I agree to photo release (optional) - view

Pictures or videos of the child listed above (such child, the “Participant”) participating in our fun classes may be included on the Kidokinetics and/or Leap-N-Laugh Corp. (dba Kidokinetics of South Bay) (together, “Kidokinetics”) websites or other advertising materials. The Participant’s name will not be disclosed. By checking this box, the undersigned is giving Kidokinetics authorization to use the Participant’s photograph and video on the Kidokinetics websites, digital marketing, social media, or other advertising materials, including but not limited to, brochures, pamphlets, or newspaper articles. The undersigned also acknowledges and agrees that such pictures, photographs, and videos are the sole property of Kidokinetics and that no royalties or payments are due in connection with their use. If you do not wish to authorize the use of the Participant’s photograph or video by Kidokinetics, please leave this box unchecked.

Assumption of Risk

Kidokinetics appreciates your confidence in our programs and we are glad to provide an opportunity for children to have fun in our programs. The undersigned, on behalf of the undersigned and the child listed above (such child, the “Participant”), acknowledge and agree that participation in Kidokinetics and Leap-N-Laugh Corp. (dba Kidokinetics of South Bay) (together, “Kidokinetics”) programs involves inherent risks, including but not limited to physical injury and illness. The undersigned voluntarily assumes all risks associated with participation in Kidokinetics programs, including any risks that may arise from negligence or carelessness of Kidokinetics directors, officers, agents and employees and other participants. The undersigned releases, waves, discharges and covenants not to sue Kidokinetics, its directors, officers, agents and employees from any and all liabilities, claims, demands, actions arising out of or related to participation in Kidokinetics programs, including but not limited to those arising from the use of equipment or facilities provided by the programs. In the event of any injury of the Participant occurring during participation in Kidokinetics programs, the undersigned hereby authorizes Kidokinetics to administer first aid and any necessary medical treatment deemed appropriate. The undersigned acknowledges and agrees that Kidokinetics will make reasonable efforts to contact emergency medical services if needed and to notify emergency contacts provided. The undersigned agrees to assume all financial responsibility for all medical treatment provided, including transportation to medical facilities if necessary. The undersigned hereby releases and holds harmless Kidokinetics, its directors, officers, agents and employees from any liability arising out of the provision of first aid or medical treatment administered.

Parent / Guardian e-Signature

The undersigned represents that the undersigned is over 18 years of age, is the parent or guardian of the child listed above (such child, the “Participant”), and may legally consent and agree to these terms on the undersigned’s behalf and on behalf of the Participant. The undersigned, on his or her own behalf and on behalf of the Participant, hereby agrees to release, waive, discharge, indemnify, defend and hold harmless Kidokinetics and Leap-n-Laugh Corp. (dba Kidokinetics of South Bay) (together “Kidokinetics”), its directors, officers, agents and employees from any and all loss, liability, damage or costs (including reasonable attorneys’ fees) arising out of or connected with the Participant’s participation in any Kidokinetics program, even though that loss, liability, damage or cost may arise due to negligence or carelessness on the part of Kidokinetics, its directors, officers, agents or employees. Further, on behalf of the undersigned and the Participant, the undersigned hereby waives any and all claims of any kind against Kidokinetics, its directors, officers, agents or employees arising from or in connection with the services provided by Kidokinetics as part of its programs, to the extent permitted by law. Additionally, the undersigned acknowledges and agrees that photos and videos of the Participant may be shared with classmates, parents and staff of Kidokinetics. By agreeing, the undersigned consents that Kidokinetics can contact them by email, SMS and/or phone regarding the Participant. These Terms and Conditions shall be governed by and construed in accordance with the laws of the State of California, without regard to conflict of laws. All disputes with respect to the Terms and Conditions, Participant Photo and Video Release and Assumption of Risk agreements that are not resolved by mutual agreement between Participant and Kidokinetics shall be resolved by binding arbitration to be conducted before JAMS, or its successor, in accordance with the JAMS Comprehensive Arbitration Rules and Procedures or its successor rules. Arbitration shall take place in Santa Clara, California.