LEBLUSH PICNICS
MINOR GUEST & LEGAL GUARDIAN CONSENT
This form is only required when a guest or customer participating in a LeBlush Picnics event is under 18 years of age.
MINOR
Minor's Full Name:
LEGAL GUARDIAN
Parent/Legal Guardian Full Name:
I confirm that I am the parent or legal guardian of the minor named above.
I give my permission for the minor to participate in the LeBlush Picnics event covered by the applicable LeBlush Picnics Customer Agreement & Waiver.
I confirm that I have had the opportunity to review the Customer Agreement & Waiver and understand the rules, responsibilities, risks, and terms that apply to the event.
I consent to the minor's participation and agree that the terms of the applicable Customer Agreement & Waiver will apply to the minor to the extent permitted by law.
SIGNATURE
Parent/Legal Guardian Name:
Customer Signature:
Date:
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone/Email:
LeBlush Picnics
This form is intended to accompany the applicable LeBlush Picnics Customer Agreement & Waiver and does not replace that agreement.
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