Emergency release form

 
 
Parent or Guardian Name (1) *
Parent or Guardian Name (1)
Parent or Guardian Name (2)
Parent or Guardian Name (2)
Phone Number
Phone Number
Address
Address
Child's Name (1)
Child's Name (1)
Child's Name (2)
Child's Name (2)
Child's Name (3)
Child's Name (3)
Child 1's Birthday
Child 1's Birthday
Child 2's Birthday
Child 2's Birthday
Child 3's Birthday
Child 3's Birthday
Emergency Contact 1
Emergency Contact 1
Phone 1
Phone 1
Emergency Contact 2
Emergency Contact 2
Phone 2
Phone 2
Liability Waiver
I agree in any event Kidology will not be held liable for any injuries, accidents, or losses suffered by my child while participating in any programming Kidology offers. It is the policy of Kidology to notify a parent/guardian when a child is ill or needs medical attention. In the event that a parent/guardian or emergency contact cannot be reached, Kidology’s representatives and/or employees will get immediate help for the child. Our procedure is to contact Coronado Fire Department and have the child transported to the nearest emergency service provider. Kidology is not liable for any financial costs incurred when taking action deemed reasonable and appropriate by it’s employees/representatives for emergency care. I have read and accept the terms of services listed within Kidology programming enrollment packet.
Electronic Signature
Electronic Signature
Please print name below.