Food waiver

Permission Slip

Please complete this form.
As part of our chess program, we offer food and snacks to our participants. We take safety and health seriously and want to make sure that any food we provide is appropriate. In order to participate in our food program, we require your permission.
Participant*

First NameAge
Participant (optional)

First NameAge
Participant (optional)

First NameAge
Participant (optional)

First NameAge
Parent/Guardian Name*

First NameLast Name
Phone Number*

Area CodePhone Number
I give permission for my child/ward to participate in the programs offered by PLEDGE. I understand that:*

The food provided is carefully selected food options with consideration of known food allergies and dietary restrictions of the participants.Any food provided may contain common allergens such as peanuts, tree nuts, dairy, wheat, soy, and eggs.PLEDGE will take reasonable steps to prevent cross-contamination of allergens, but cannot guarantee that the food will be completely allergen-free.It is my responsibility to inform instructors of any food allergies or dietary restrictions my child/ward may have before receiving a meal.I release PLEDGE from any liability for any injury or illness resulting from my child/ward's participation in the chess program.
Any food allergies or dietary needs?
Signature*

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Email*
example@example.com
Date*

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Today's Date
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