Childcare Service Liability Waiver

I, the undersigned, acknowledge that I am registering my child to participate in childcare services provided by the organization. I understand and agree to the following:

• I voluntarily assume all risks related to injuries or illness that may result during the participation of my child.
• I hereby release and hold harmless the childcare providers, staff, and affiliated parties from any and all liability resulting from injuries, accidents, or incidents.
• I certify that I am the parent or legal guardian of the child(ren) listed below and have full authority to sign this waiver.

Parent/Guardian Information

Name Address Phone Number Email

Child(ren) Information

Child’s Name Date of Birth Allergies/Medical Conditions

Emergency Contact

Name Phone Number

Signature & Date

Signature Date