We, the parents of the youth listed on this form, who plan to participate in ICEV Youth Program which require the youth to stay from 6:00 pm until she leaves the facility hereby waive all claims against ICEV and its officers, directors, employees and, volunteers in case of any accidents, incidents or medical emergency during their stay. We also agree that we will assume full financial responsibility and pay for any damages to ICEV facility, equipment, furniture etc. caused by our children. *
Parent Full Name as signature