Friday Evening Child Care

Parent/Guardian Name(Required)

First Last

This is the name of the parent or guardian that is authorized to pick up and drop off. No other person will be authorized to pick up the child. Please put the legal name (exact name on ID) of the parent/guardian who will be picking up/dropping off.

Date(Required)

Parent/Guardian Phone Number(Required)

Parent/Guardian Email Address(Required)

Child Name(Required)

First Last

Child's Date of Birth(Required)

Please list any known allergies your child has.

Agreement, Waiver and Release

I have carefully read the description of program(s) for which I/We are registering and in consideration for being permitted by the Wrightwood Community Services District to participate in the (above) activity as that may be modified from time to time, I hereby waive, release, and discharge any and all claims for damages for personal injury, death, or property damage which I may have, or which may hereafter accrue to me, as a result of participation in said activity. This release is intended to discharge in advance the Wrightwood Community Services District (its officers, employees, and agents) from any and all liability arising out of or connected in any way with my participation in said activity, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above. It is understood that this activity involves an element of risk and danger of accidents and knowing those risks I hereby assume those risks. It is further agreed that this waiver, release, and assumption of risk is to be binding on my heirs and assigns. I agree to indemnify and to hold the above persons or entities free and harmless from any loss, liability, damage, cost, or expense which they may incur as the result of my death or any injury or property damage that I may sustain while participating in said activity. I understand that this waiver is good for a calendar year.(Required)

I HAVE CAREFULLY READ THIS AGREEMENT, WAIVER, AND RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND THE WRIGHTWOOD COMMUNITY SERVICES DISTRICT AND I SIGN IT OF MY FREE WILL. I FURTHER UNDERSTAND AND AGREE THAT I MUST ABIDE BY ALL APPLICABLE DISTRICT ORDINANCES, RULES, REGULATIONS, AND CODE OF CONDUCT, FOUND ON WRIGHTWOODCSD.ORG, AND THAT CONTINUED PARTICIPATON IS SUBJECT TO SUCH COMPLIANCE.

Child's Name(Required)

First Last

Date(Required)

Parent/Guardian Signature(Required)

First Last