Kid'S Climbing Registration Form (Page 2 of 3) in pdf

Kid'S Climbing Registration Form Page 2

ADDITIONAL INFORMATION _________________________________________________________

________________________________________________________________________________

EMERGENCY CONTACTS (Name, Phone Numbers, Address) Authorized to Pickup Your Child:

________________________________________________________________________________

SHOULD THE STAFF RECOGNIZE THE NEED TO APPLY SUNSCREEN TO MY CHILD, I AUTHORIZE THEM TO

DO SO

I GIVE MY CONSENT FOR MY CHILD TO BE TRANSPORTED AND OR WALK TO ALL ACTIVITIES. THIS

INCLUDES BUT IS NOT LIIMITED TO EASTON TRAINING CENTER AND OUTSIDE CLIMBING AREAS.

I HEREBY GRANT PERMISSION FOR ABC KIDS CLIMBING TO TAKE NECESSARY STEPS TO OBTAIN

EMERGENCY MEDICAL CARE UNTIL I CAN BE CONTACTED. IN EVENT OF A SERIOUS MEDICAL EMERGENCY,

ABC KIDS CLIMBING HAS MY PERMISSION TO CALL AN AMBULANCE TO TRANSPORT MY CHILD FOR

EMERGENCY MEDICAL TREATMENT. I ACCEPT FINANCIAL RESPONSIBILITY FOR ALL COSTS ASSOCIATED

WITH THE CONVEYANCE OF MY CHILD AND FOR THE TREATMENT PROVIDED BY THE MEDICAL CARE

FACILITY TO MY CHILD.

Parent or guardian signature___________________________ Date:______________

Print name:_________________________________________________

ABC KIDS CLIMBING 1960 32nd St. Boulder CO. 80303 720 2445514

Kid'S Climbing Registration Form Page 2