Consent and Liability Waiver Form
Please read and complete this form to acknowledge your understanding and acceptance of the terms for participation.
School Holiday Program September/October 2026
Participant Name
*
First Name
Last Name
Parent/Guardian Name (if participant is under 18 years of age)
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Does the participant have any allergies or medical information the supervisors need to be aware of? (please list below)
*
Signature
*
I DO NOT consent to the use of my images (if left blank, you do consent to the use of images that may be taken of participant for social media, reporting and planning purposes)
I DO NOT consent to the use of my images
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
Should be Empty: