I hereby voluntarily release and forever discharge Pamela Samuelson, The Center for the Advancement of Body Literacy, 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 this program.
The information I've given in this form is complete and accurate. By signing this form, 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.