Liability Release Form printable pdf download

Liability Release Form

The Walnut Hills Early Education Preschool (W.H.E.E. Preschool) requires the

following Liability Release form signed by both parents before your child can enter the

preschool program.

Child’s Name _________________________________________ Age ______

Address ________________________________________________________

Home Phone # ______________________ Cell Phone # _________________

Parent’s Names __________________________________________________

IF PARENTS CANNOT BE CONTACTED PLEASE NOTIFY:

Name ______________________________ Phone __________

Doctor’s Name _______________________ Phone __________

I/We hereby assume all risk of personal injury for all the years my child is attending or

participating in Walnut Hills Early Education (W.H.E.E. Preschool) activities. I/We give our

permission to the school to call a doctor or paramedic for medical care for my child should an

emergency arise. It is understood that a conscientious effort will be made to locate the child’s

parent or guardian before further action takes place. However, if it is not possible to locate a

parent this expense will be accepted by us.

I/We hereby release Walnut Hills Early Education (W.H.E.E.) director, staff, and

Board Members from any and all liability arising from of claims for injuries or damages that

either individually or on behalf of your child might occur while any of these individuals are

performing any of their duties.

Parent/Guardian ____________________Date ___________________________

Parent/Guardian ____________________Date____________________________

Liability Release Form