Accident Waiver And Release Of Liability Form Providence Heights printable pdf download

Accident Waiver And Release Of Liability Form Providence Heights

Accident Waiver and Release of Liability Form

I, _______________________, give permission for my child,_____________________ to participate

in physical education class, recess and general school activities while shadowing at Providence Heights Alpha

School. I do hereby release and forever discharge Providence Heights Alpha School and the Sisters of Divine

Providence located at 9000 Babcock Boulevard, Allison Park, PA 15101 from any and all actions or suits in law

or equity which I might hereafter have by reasons of injuries sustained by my child.

This accident waiver and release of liability shall be construed broadly to provide a release and waiver to the

maximum extent permissible under applicable law.

I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT. I AM

AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT ON MY OWN FREE

WILL.

________________________________

_________________

Child’s Name

Date of Birth

________________________________

_________________

Signature of Parent or Guardian

Date

Child does ☐ does not☐ have a food allergy.

In the event of an emergency, please contact:

_________________________________

__________________

Name

Phone Number

_________________________________

Relationship

_________________________________

__________________

Name

Phone Number

_________________________________

Relationship

Accident Waiver And Release Of Liability Form Providence Heights