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Parent Release Waiver
This waiver is for children 12-17 years old that will be utilizing the SBTS Health & Rec Center. A parent/legal guardian must fill out the information below.
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* Indicates required question
Email
*
Your email
Today's Date
*
MM
/
DD
/
YYYY
Parent/Legal Guardian Full Name
*
Your answer
Are you affiliated with SBTS/Boyce?
*
Choose
Yes, I am a SBTS/Boyce student spouse.
Yes, I am a SBTS/Boyce employee.
Yes, I am a SBTS/Boyce employee spouse.
No, but I am the parent of a Boyce Student.
Yes, I have an HRC Community Membership.
No, I am not affiliated with SBTS/Boyce.
No, I am attending an outside event.
Child's Full Name
*
Your answer
Child's Age
*
Choose
11
12
13
14
15
16
17
Gender
*
Male
Female
Emergency Contact Name
*
Your answer
Emergency Contact Number | (xxx)xxx-xxxx
*
Your answer
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