PARENT/GUARDIAN PERMISSION FORM FOR YOUTH PARTICIPANT
Please complete this REQUIRED form to sign-up your child for White Oak PFC "Fun" Raiser Party.
Child's Full Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Grade
TK
KINDERGARTE
1st
2nd
3rd
4th
5th
Teacher
Parent/Guardian’s Name(s)
First Name
Last Name
Parent/Guardian’s Phone Number
-
Area Code
Phone Number
Parent/Guardian’s Email
example@example.com
Emergency Contact Full Name (other than parent/guardian listed above):
First Name
Last Name
Emergency Contact Phone Number:
-
Area Code
Phone Number
Event your child is attending
TK/K Reptile Party
1st Grade Party w/ Coach Ryan
2nd Grade Magic Show Party
3rd Grade Party w/ Coach Ryan
4th Grade Pool Party
5th Grade Pool Party
Is your child attending the YMCA after school? If so do you give permission for the host to walk your child back to the YMCA?
Yes
No
Other
Please list any allergies or medical conditions that the hosts should be aware of:
PICK-UP AUTHORIZATION & RELEASE
I parent/guardian named above give permission for the following person(s) to pick-up my child (named above) from the event. I understand that my child will only be permitted to leave with the parent/guardian or the person(s) named here unless I notify the host of the event.
Name
First Name
Last Name
Name
First Name
Last Name
Parental Permission and Release of Liability
I understand volunteers will supervise the event. If a serious illness or injury develops and medical and/or hospital attention is necessary, I give permission for emergency treatments or surgery as recommended by an attending physician. I specifically release and discharge, in advance, PFC of White Oak, its directors, and volunteers from any and all liability, whether known or unknown. I agree to accept responsibility for the risks that may occur. I hereby agree to waive, release and discharge any and all claims for damages, for death, personal injury or property damage which my child may have or which may hereafter accrue as a result of my child’s participation in this program against their person or entity whether such injury or damage was foreseeable. This acknowledgement of and assumption of risk and release shall be binding upon heirs and assigns.
Signature
*
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: