Parent Consent Form (Volunteer) printable pdf download

Parent Consent Form (Volunteer)

1. This form is applicable to youth aged 13 to 16.

2. The form must be completed and brought along by the youth volunteer on the day of the activity in

order for him/her to participate in it.

3. Those w ithout the completed form w ill be turned aw ay.

* Delete w here applicable

I, ____________________________________, NRIC/ FIN/ Passport No. ___________________, * parent/

guardian of ___________________________________________ (volunteer’ s name), hereby give my consent

to my

* child/w ard’ s participation in the Alzheimer’ s Disease Association (ADA) activity

_________________________________________________________________________ (activity

name) on

__________________ (date), from ______________ am/pm* to ______________ am/pm* .

I understand that as a volunteer w ith ADA, my child/w ard w ill be volunteering his/her services solely

for his/her personal purpose or benefit w ithout promise or expectation of compensation or benefits.

I understand that ADA and its representatives w ill take all reasonable steps to provide individual care

and safety for each child, but I am aw are that ADA and its staff cannot assume responsibility for any

injury, loss, damage or harm to any child or to his/her property during the course of the activity,

including travelling to and from the activity site.

I w ill therefore not take any legal actions and/or claims against ADA staff, volunteer leaders and all

persons and/or agencies connected w ith this activity from all claims and damages (personal injuries,

mishap, etc) arising from my child/w ard’ s participation before, during and after the activity.

I fully understand the above agreement, and w ill not hold ADA and its employees responsible for any

action taken for professional emergency services performed.

I also declare that my child/w ard is medically and mentally fit to participate in this activity. I am aw are

that I can seek legal advice or have already sought legal advice, in respect of this w aiver of liability

before signing this document .

Parent/Guardian’ s NRIC/FIN No.:

Parent/Guardian’ s Contact No.:

Parent/Guardian’ s Name:

Signature of Parent/Guardian

Permission is hereby given for any photos of my child/w ard to appear in any and all media, publications,

advertising and publicity, in connection w ith his/her participation in this ADA activity.

Yes / No *

Parent Consent Form (Volunteer)