Registration and Liability Release Form

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Ness City Public Library 2023 Summer Youth Program

Child's Name *

Parent/Guardian Name *

Parent/Guardian Phone *

I acknowledge that Ness City Public Library may take photographs of me/my child while participating in Summer Program activities and I grant permission for the library to use said photographs for the purpose of promoting and informing the community of library programs. *

Yes

Please list all known allergies: *

Please list any physical restrictions: *

This release is for any and all liability for personal injuries and property losses or damage occasioned by, or in connection with, Ness City Public Library Summer Program. The undersigned agrees to abide by all rules and regulations set forth by Ness City Public Library and/or its affiliates throughout the Summer Reading Program. In the event that the individual(s) registered in any Ness City Public Library sponsored program(s) is in need of treatment at any emergency room or medical care facility, the participant’s instructor, or any employee of Ness City Public Library and/or other sponsoring agencies, has my consent to authorize treatment for the participant(s) by the doctor(s) of their choosing as the doctor(s) may deem necessary if I cannot be reached. I, the undersigned, do hereby acknowledge that I have granted permission for me/my child to participate in any and all Ness City Public Library program(s) with full knowledge of the risks involved and I hereby agree to assume those risks and to hold Ness City Public Library, other sponsoring agencies and all of their representatives free from liability for any injury, harm, or complication resulting from said participation in any and all program(s). Furthermore, I do understand that accident insurance is not provided by the Ness City Public Library and/or other sponsoring agencies, and I hereby agree to assume full responsibility for any and all medical expenses resulting from any accidents or injuries suffered by me and/or my child while participating in said program(s). *

I have read the above statement and release Ness City Public Library from any and all liability related to my/my child's participation in the Summer Reading Program.

Required

These events are geared towards Pre-K and Younger and will last approximately an hour. We ask that children be accompanied by an adult or babysitter. Older siblings are welcome, but the content of the program will be geared toward a young audience. More information on each event can be found by visiting our website, social media pages, or calling/visiting the library. In order for us to have enough supplies for each participant, please indicate which events your child plans to attend:

6/14/23 Monkey Around - 10:00 am - Community Building

6/21/23 Share-a-Story - 12:00 pm - Lunch Served - Library

6/28/23 Splish Splash - 10:00 am - HS Football Field

These events will be geared towards Elementary age children. Younger siblings are welcome but must be accompanied by an adult or babysitter and activities will be directed towards the K-6 age group. More information on each event can be found by visiting our website, social media pages, or calling/visiting the library. In order for us to have enough supplies and plan for transportation for the field trip, please indicate which programs your child will attend:

6/13/23 Slip N Slide - 1-5 pm come and go - HS Football Field

6/20/23 Eastbound and Down - 8:30-4:30 - Larned and Great Bend Field Trip

6/27/23 Camp Rewind - 10-3 - Community Building

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