2016/2017 Monday Homeschool Classes Activity waiver

(also applies to all mhc activity groups, including but not limited to tag and the tween club)



I _________________________________________________ hereby waive Monday Homeschool Classes and all MHC activity group and event teachers, chaperones, and volunteers from any liability of injury, loss or damage to personal property associated with their activities.  I understand that if I am not present at the event or activity that I am responsible to provide my child’s health/safety information to the adult of my choice to act as my child’s advocate. In the event of an emergency this advocate can make necessary medical decisions with the understanding that all appropriate efforts will be made to contact a parent or guardian.


I acknowledge that I understand the content of this document and I am aware that it is legally binding and I sign it under my own free will.


Signature or parent/legal guardian: ____________________________________Date: __________


Print name: ______________________________________________________________________




Print Name(s) of Parent/Legal Guardian: _______________________________________________

Parent/ Legal Guardian Cell Phone: ___________________________________________________

Parent/ Legal Guardian Home Phone: _________________________________________________

E-mail: __________________________________________________________________________

Physician Name: __________________________________________________________________


Student Health/Safety Information:

Student Name: ________________________________ Birth Date: _________________________

Allergies or other medical information: ______________________________________________________________________________



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