2022 Walk/Bike Waiver

By signing this waiver, I authorize BrainVyne Inc to allow:

Camper's Full Name*

First NameLast Name

Date of Birth*

Age*

Which site is your child attending camp? Eg: Hoover Elementary, Cubberley D5 etc

(Check all that apply)

To (Camp site and be responsible for locking and storing bikes appropriately)*

WalkBikeTake Public Transportation

To Camp:*

From Camp:*

Without adult supervision at the designated times.

A signed form is required on record or your child will need to be signed in by an authorized adult and released to authorized adult. You will be called to pick him/her up.

For early departures or late arrivals parent or guardian must notify 24hrs prior by emailing info@brainvyne.com or texting complete name of child to 650-469-3409

Signature of this waiver releases BrainVyne Inc from all liability with regards to your camper’s safety while traveling including wearing safety equipment when biking and following pedestrian rules. We are not responsible for lost bikes.

Parent Name (Print)*

Phone Number*

Area CodePhone Number

Date*

Signature

ARRIVAL AND DEPARTURE WAIVER