Library in the Park Waiver Form

Calling all tweens!

This summer we’ll be heading to Koenig Field for “Library in the Park”!
Check-in will be at the library at 2 pm. We’ll then be walking down to Koenig Field for: field games, a snack, and then a craft. Then we'll walk back to the library for pick-up at 4 pm.

Registration and a signed waver are required for participation.
Ages 8-12

Name of the Child*

First NameLast Name

Name of the Parent/Guardian*

First NameLast Name

Parent/Guardian's Phone Number*

Format: (000) 000-0000.

Parent/Guardian's Email Address*

example@example.com

Parent/Guardian's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Are there any allergies that we should be made aware of? (Food or Enviromental)*

Statement of Consent & Waiver

I hereby agree and declare that I am the legal parentguardian of the above-named child and hereby consent to the child's participation in the activities that are described to me in the registration process. I understand that activities of the kind described may result in physical injury to my child but nonetheless specifically request that they are allowed to participate in those activities.

If the above-named child 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).

I, the parent/guardian, hereby agree and declare that I have carefully read and understand the scope of the Library in the Park activities and I consent to the participation of the above-named child to these activities.

Any type of injury that may occur to the child without the fault of the library management and activity supervisors, the library management cannot be held responsible for any harm that may occur to the child without the fault of the library management and activity supervisors.

Parent/Guardian Signature*