Summer Camp Activity Waiver Form

Release of Liability Form

This form is for E-Learning and Professional Development Day Program at First Meridian Heights Presbyterian Church
This form is valid for the entirety of the 2024-2025 School Year.
Name of the Child*

First NameLast Name
Name of the Child

First NameLast Name
Name of the Child

First NameLast Name
Name of the Child

First NameLast Name
Statement of Consent & Waiver

I hereby agree and declare that I am the legal parentguardian of the above-named child(ren) and hereby consent to the child(ren)'s participation in the E-Learning/Professional Development Day Program at First Meridian Heights Presbyterian Church.

If the above-named child(ren) requires any emergency medical treatment or procedures during the activities, I hereby consent to activity supervisor(s) to make any decision and take any action to arrange for such procedures or treatments in the discretion of the activity supervisor(s).

By signing this agreement, I agree to hold FMHPC harmless, including financial responsibility for any injuries sustained.
Name of the Parent/Guardian*

First NameLast Name
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Release of Liability Form