Homes of Hope Childcare Permission & Waiver

Homes of Hope Childcare Permission & Waiver

Complete this form to provide required permissions and emergency information for your child's participation in Homes of Hope childcare activities. (Complete an additional form for more than 3 children.)
The adult training I am participating in
Child 1 Information

Required
Child 1 Full Name

First NameLast Name
Child 1 Date of Birth

MonthDayYear
Date
Medical Information
Does your child have any allergies?
If yes, please list allergies:
Does your child require medication or have any medical conditions?
If yes, please list medications/conditions:
Child 2 Information
Child 2 Full Name

First NameLast Name
Child 2 Date of Birth

MonthDayYear
Date
Medical Information
Does your child have any allergies?
If yes, please list allergies:
Does your child require medication or have any medical conditions?
If yes, please list medications/conditions:
Child 3 Information
Child 3 Full Name

First NameLast Name
Child 3 Date of Birth

MonthDayYear
Date
Medical Information
Does your child have any allergies?
If yes, please list allergies:
Does your child require medication or have any medical conditions?
If yes, please list medications/conditions:
Parent/Guardian Contact
Parent/Guardian Full Name (the person who will be at the training)

First NameLast Name
Relationship to Child 1
Relationship to Child 2
Relationship to Child 3
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Parent/Guardian Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contacts

Alternative contact other than person attending training
Emergency Contact(s)
Activity and Transport Permission
I give permission for my child to participate in all scheduled activities and to be transported by Homes of Hope staff or volunteers as needed.
Optional Photo/Media Release
I give permission for my child's image to be used in photos or media by Homes of Hope.
Childcare Release of Liability/Hold Harmless Agreement
By signing below, you agree to RELEASE FROM LIABILITY AND HOLD HARMLESS Homes of Hope, a registered Non-Profit located at 818 17th Ave, Lewiston, ID 83501, including its employees, volunteers, board of directors and officers, from all claims, liability, negligence, damages, judgments, medical payments or demands for monetary relief of any kind in connection with the childcare being provided for your child/children, including any activities which may result in injury, harm, or other damages.
Signature
Date

MonthDayYear
Date
Should be Empty:

Homes of Hope Childcare Permission & Waiver

Child 1 Information

Medical Information

Child 2 Information

Medical Information

Child 3 Information

Medical Information

Parent/Guardian Contact

Emergency Contacts

Activity and Transport Permission

Optional Photo/Media Release

Childcare Release of Liability/Hold Harmless Agreement