Parental Consent and Release Form

I, the undersigned   First Name   Last Name   , am the parent or legal guardian of the child/youth named   First Name   Last Name, who was born on Date       and resides in   Street Address   Address Line 2   City   State   Zip    . For any situation, I assure that I will be available for the phone call at    Area Code   Phone Number   . As a parent or legal guardian, I affirm that I have been completely informed all the sport activities that the child/youth will participate. I understand the general structure of the sport activities/programs and do not need to be informed of each and every activity.

I hereby voluntarily release, forever discharge Boomerang Coffee Co., the community, the corporation, its officers, directors, employees, volunteer and agents from any and all claims, demands, or causes of action, which are connected with my child's participation in the programs or the use of the equipment and facilities. I agree to pay for any and all medical expenses incurred and give permission to the doctor or health care professional to provide medical care if necessary. The information I've given in this form is complete and accurate. By signing this form on      Date  , I confirm that I have fully informed myself of the contents of this Parental Consent and Release Form by reading it before I signed it. I warrant that I possess all the rights, powers, and privileges of a parent or legal guardian necessary to execute this document with binding legal effect.First NameLast NameSignature