In consideration of being allowed to enter into the play arena and/or participate in any party and/or program at Jumpin' Beans, the undersigned, on his or her own behalf, and/or on behalf ofthe participant(s) identified below, acknowledges, appreciates and agrees to the following conditions:

I willingly agree to comply with the stated and customary terms, rules and conditions for participation in any party and/or program at Jumpin' Beans. In addition, if I observe any hazard during my participation, I will bring it to the attention of the nearest official immediately; I am aware that there is a risk of injury from the inflatable equipment, and while particular rules, equipment, and personal discipline reduce the risk, the risk does exist.

I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of other participants; and, I for myself, and on behalf of my heirs, assigns, personal representatives, and next of kin, hereby hold harmless, Planet Air, Inc. of Cary, NC their affiliates, officers, members, agents, employees, other participants, and sponsoring agencies with respect to any and all injury, disability, or loss or damage to person or property to the fullest extent of the law.

Participant Name/Date of Birth: ___________________ D.O.B__/__/__
Participant Name/Date of Birth: ___________________ D.O.B__/__/__
Participant Name/Date of Birth: ___________________ D.O.B__/__/__
Participant Name/Date of Birth: ___________________ D.O.B__/__/__

Address: Street_______________________________ City _______________ Zip__________

Email (to receive online coupons) __________________@_____________________
How did you hear about us? (CIRCLE) : Cary Mall , Yellow Pages, Friend, TV, Web, Other
Parent/Guardian Name (Print) ___________________
Parent/Guardian signature ___________________Date__________