Fossil Program at Huntington City - Township Public Library
Tuesday, November 12th, 2024 4:30 - 6:00pm
Child/Children Registration
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Guardian Name
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First Name
Last Name
Guardian E-mail
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example@example.com
Mobile Number
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Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I hereby grant permission to Speaks for Trees and More and HCTPL to use photographs and/or video taken during this event in publications, news releases, online, and other communications.
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I, legal guardian of child(ren) listed above, authorize Speaks for Trees and More and HCTPL to seek, obtain, and consent to emergency medical care & treatment as deemed necessary by a medical professional.
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I hereby release, Speaks for Trees and More and HCTPL from any and all damages, injuries, causes of action which may accrue to or be asserted by me or any child(ren) of mine arising directly or indirectly from my child’s participation in the HCTPL Fossil Program event.
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Signature
Date
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Month
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Day
Year
Date
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