Parent/Guardian Waiver and

Release Form

Please complete this waiver form for your child's participation in our activities. All fields marked with * are required.

Child's full name

Child's date of birth

Month

Day

Year

Contact email address

Parent/guardian last name

Parent/guardian first name

Phone number

Please provide an emergency contact other than yourself

Emergency contact name

Emergency contact phone

Relationship to child

Known allergies or medical conditions

By signing below, I acknowledge that I have read and understand the following:

I understand that participation in activities involves inherent risks
I voluntarily assume all risks associated with my child's participation
I release and hold harmless the organization, its staff, and volunteers from any claims or liability
I give permission for my child to participate in all planned activities
I authorize staff to seek emergency medical treatment if needed

I have read, understood, and agree to the terms of this waiver and release form

I authorize emergency medical treatment for my child if I cannot be reached

Parent/guardian signature

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Your digital signature serves as your legal agreement to this waiver

Date signed

Month

Day

Year