Babysitting Release Form

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Release of liability - Oregon Marathi Mandal

Email *

Parent/Legal Guardian Full Name *

Phone Number *

Home Address *

Emergency Contact - Full Name *

Emergency Contact - Phone Number *

Child's Full Name *

Child's Age (Child's age need to be 5 and up) *

Cheese Pizza, cupcakes & fruits juice will be provided. *

Yes

Required

Please indicate any behavior issues/allergies of your child that would help us. *

I hereby accept all responsibilities for and assume the risk of all injuries or damages to my child that might arise directly or indirectly as a result of, and a participation in the Babysitting Service. I release discharge and hold harmless from any liability whatsoever Oregon Marathi Mandal and its officers, trustees, volunteers, and members, and all other persons. I am familiar with the contents of this release. *

Yes

Required

Parent/Legal Guardian Signature (Enter your Full Name) *

Date *

YYYY

A copy of your responses will be emailed to the address you provided.

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