Temporary Guardian Form printable pdf download

Temporary Guardian Form

Date: _____________________________

ClubWorx Management

I am the parent of ______________________________ and I do hereby give my permission to

and appoint ______________________________ as a temporary guardian(s) of my minor child(ren)

during the time period (date) ____________________ to ____________________.

I accept full responsibility for my child(ren)s attendance and participation in any activities while at ClubWorx including (his/her) use of any and all apparatus,

appliance, facility privilege or service whatsoever, owned and operated by this club. I shall hold this club, it’s shareholders, directors, officers, employees,

representatives and agents harmless from any and all loss, claim, injury, damage, or liability sustained or incurred by my child(ren) resulting therefrom.

Said temporary guardian may make any and all necessary decisions about my child(ren)’s emergency medical treatment while at ClubWorx during the time

listed above.

_________________________________________ (Parent)

**A Guardian is defined as a person 21 years of age or older who is legally in charge of the affairs of a minor. The above statement makes such a person a

“temporary” guardian of a minor.

**ClubWorx will allow a young adult who is at least 18 years of age to bring their sibling(s) who are at least 10 years of age to ClubWorx if they are both

on their parents’ ClubWorx membership and this agreement has been signed by the parent.

**Prospective Members who are using ClubWorx by means of a 5-day pass will ONLY be allowed to bring their biological dependent children to the club

with them. Guests will not be permitted.

ClubWorx Temporary Guardian __________________________________________

Employee__________________________________________________________