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Mixed Gaming Participant Waiver

PARENT / LEGAL GUARDIAN

GAMER INFO

Gamer Date of Birth
Month
Day
Year

EMERGENCY CONTACT INFO

MINOR AGE & SUPERVISION POLICY

Children under age 12: A parent or legal guardian, or another responsible adult age 18 or older authorized by the parent/guardian, must remain onsite at Mixed Gaming for the duration of the child's visit.


Ages 12–17: A parent or legal guardian is not required to remain onsite if a current parent/guardian waiver and drop-off authorization are on file.


Mixed Gaming is an entertainment facility and does not provide childcare or individual supervision. Parents and legal guardians are responsible for determining whether a participant age 12 or older is mature enough to remain at Mixed Gaming without them.


A parent/guardian of an unaccompanied minor must remain reachable by phone during the participant's visit and must arrange for the participant to leave or be picked up by the end of the purchased gaming period and no later than closing time.


Mixed Gaming reserves the right to require a parent/guardian to remain onsite or return to the facility if a participant cannot safely or appropriately remain without them.

DROP-OFF & PERMISSIONS

For participants age 12–17, do you authorize this participant to remain at Mixed Gaming without a parent/guardian onsite?
YES — I authorize this participant to remain at Mixed Gaming without me onsite. I understand that I must remain reachable by phone and that Mixed Gaming does not provide childcare or individual supervision.
NO — A parent/guardian or responsible adult will remain onsite with this participant.
Photo & Video Permission
Yes — I give Mixed Gaming permission to photograph or record this participant for use on Mixed Gaming's website, social media, and promotional materials.
No — I do not give Mixed Gaming permission to intentionally photograph or record this participant for promotional purposes.
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