Liability Waiver/Permission Slip
Child's Information
Tell us about the person participating
Emergency Contact Info
Child's and Guardian Info
Child's Name
Address, City, State, Zip
Child's Phone
Child's email
Parent/Guardian Name
Parent/Guardian Phone
Parent/Guardian email
Emergency Contact Info
Emergency Contact Name
Emergency Contact Phone
Emergency Contact Relation to Child
Waiver
Event where the child is participating
Liability Waiver: I am aware that participation in the above-mentioned event has some inherent risks and injury that can occur. On rare occasions, these injuries can be serious. In consideration of my child being allowed to participate in the My Grandma’s House event, I, the parent/guardian, assume the risk of all injury and agree not to hold My Grandma’s House, the directors, staff, coordinators, volunteers liable for any harm or damage caused to my child resulting from his/her participation in any My Grandma’s House events or activities. By signing this waiver, I also authorize the use of pictures of the above-named participant to be posted on the My Grandma’s House website and social media outlets pertaining to the event.