Parent & Student Waiver of Liability Form
PARENT AND STUDENT WAIVER FALL 2013
As a participant in either the IN THE HILLS CO-OP AT CAFTA (CONNECTICUT ACADEMY FOR THE ARTS), 61 MAIN STREET, TORRINGTON, CONNECTICUT, AND/OR DOWN THE VALLEY CO-OP AT THE BEACON VALLEY GRANGE, 1354 NEW HAVEN ROAD, NAUGATUCK, CONNECTICUT, I (we), as parent(s) of the minor(s) herein specified, and as adult participants of in the Hills and/or Down The Valley, do hereby hold harmless, release, and forever discharge:
IN THE HILLS AND DOWN THE VALLEY, individual members of the coop & leaders of the coop
CAFTA (CONNECTICUT ACADEMY FOR THE ARTS) AND BEACON VALLEY GRANGE, its officers, employees, and agents acting officially or otherwise, from any and all claims, demands, and actions for damages or causes of action on account of the referred and on account of ourselves as participants.
I (we) have read, understand, and agree to abide by all In The Hills and Down The Valley policies.
NAME
Date of Birth (month/year)
1.
______________________________________________________________________________________
2.
______________________________________________________________________________________
3.
______________________________________________________________________________________
4.
______________________________________________________________________________________
5.
______________________________________________________________________________________
I hereby certify that this/these minor(s) is/are my (our)
sons/daughters and that his/her date of birth is correct.
_____________________________________
_____________________________________
(Signature)
(Print Name)
(Date)
____________________________________
____________________________________
(Signature)
(Print Name)
(Date)
________________________________________________________________________________________
(Address)
(City)
(Phone)
_____________________________________
_
(Witness Signature)
(Print Name)
(Date)
As a participant in either the IN THE HILLS CO-OP AT CAFTA (CONNECTICUT ACADEMY FOR THE ARTS), 61 MAIN STREET, TORRINGTON, CONNECTICUT, AND/OR DOWN THE VALLEY CO-OP AT THE BEACON VALLEY GRANGE, 1354 NEW HAVEN ROAD, NAUGATUCK, CONNECTICUT, I (we), as parent(s) of the minor(s) herein specified, and as adult participants of in the Hills and/or Down The Valley, do hereby hold harmless, release, and forever discharge:
IN THE HILLS AND DOWN THE VALLEY, individual members of the coop & leaders of the coop
CAFTA (CONNECTICUT ACADEMY FOR THE ARTS) AND BEACON VALLEY GRANGE, its officers, employees, and agents acting officially or otherwise, from any and all claims, demands, and actions for damages or causes of action on account of the referred and on account of ourselves as participants.
I (we) have read, understand, and agree to abide by all In The Hills and Down The Valley policies.
NAME
Date of Birth (month/year)
1.
______________________________________________________________________________________
2.
______________________________________________________________________________________
3.
______________________________________________________________________________________
4.
______________________________________________________________________________________
5.
______________________________________________________________________________________
I hereby certify that this/these minor(s) is/are my (our)
sons/daughters and that his/her date of birth is correct.
_____________________________________
_____________________________________
(Signature)
(Print Name)
(Date)
____________________________________
____________________________________
(Signature)
(Print Name)
(Date)
________________________________________________________________________________________
(Address)
(City)
(Phone)
_____________________________________
_
(Witness Signature)
(Print Name)
(Date)