Release Of Liability And Assumption Of Risk Agreement (Minor) (Page 4 of 4) in pdf

Release Of Liability And Assumption Of Risk Agreement (Minor) Page 4

____ My child is to remain at PSAL’s host site until PSAL activities have concluded each day and I will pick my

child up from PSAL’s host site.

____ My child is to remain at PSAL’s host site until PSAL activities have concluded; however, I give my child

permission to walk home after PSAL activities have concluded each day.

____ I give my child permission to voluntarily leave (walk away from) PSAL activities/host site on his/her own

volition (choosing) at any time even if PSAL activities are still in progress. Children who are given permission to

leave voluntarily on their own volition and choose to leave will not be allowed to return to PSAL on that same

day.

If you choose to have your child(ren) remain in PSAL’s program until activities have concluded, but there is a day

your child(ren) needs to leave PSAL’s program prior to the conclusion of any particular days activities and you

are not picking your child(ren) up on that day, please send a note with your child(ren) indicating your

child(ren) will be leaving early that day.

______________________

Child’s Name (Please Print)

_______________________

______________________

____________

Parent Name (Please Print)

Parent/Guardian Signature

Date

Release Of Liability And Assumption Of Risk Agreement (Minor) Page 4