Elf Academy

Child’s Name*

First NameLast Name

Child’s DOB*

Date

Child’s Grade in school*

Child’s Name (#2)

First NameLast Name

Child 2 DOB

Date

Child 2 Grade in School

Child’s Name (#3)

First NameLast Name

Child 3 DOB

Date

Child 3 Grade in School

Parent / Caregiver’s Name*

First NameLast Name

Parent’s Phone Number*

Please enter a valid phone number.

List medical conditions or accommodations needed, if applicable

List any allergies or dietary restrictions

Emergency contact ( and eligible pickup person, if different from parent/ caregiver listed above) *

First NameLast Name

Emergency Contact phone number *

Please enter a valid phone number.

Any behavior or safety issues we should be aware of for your child(ren)?*

Select your ticket option*

Elf JrElf Jr + supervisionVIP ElfVIP Elf + supervision

How did you hear about this event?

FacebookWord of MouthWebsiteOther

Did you pay already?*

Yes (thank you!)No— remember, your space is not reserved unless payment is received! Actionky.org/fundraisers

I understand that all payments are donations supporting ACTION Inc.’s Village Center and are non-refundable.*

Yes

I give permission for my child’s photo to be taken and possibly used in ACTION Inc. promotions or social media.*

YesNo

Liability Waiver and Release

I, the undersigned parent or legal guardian, hereby give permission for my child to participate in Elf Academy, hosted by ACTION Inc. on November 22, 2025, at 901 Beauty Ave., Bowling Green, KY.

I understand that every effort will be made to ensure a safe and enjoyable environment. I acknowledge that participation in activities such as crafts, games, and interactive stations may involve a small risk of injury. I hereby release and hold harmless ACTION Inc., its staff, volunteers, agents, and affiliates from any and all liability, claims, or demands for personal injury, illness, property damage, or other loss that may arise from my child’s participation in this event.

In the event of an emergency, I authorize the staff or volunteers of ACTION Inc. to secure any necessary medical treatment for my child. I accept full financial responsibility for any medical care deemed necessary by a licensed healthcare provider.

I understand that all payments for this event are considered donations supporting the furnishing and development of the Village Center, and are therefore non-refundable.

By signing below, I acknowledge that I have read and understand this waiver and agree to its terms.

Signature*