Grandkid Investigator Holiday Caravan - Guardian Consent & Responsibility/Registration Form

Please complete this form to give permission for your child or teen to participate in the event. By submitting, you acknowledge responsibility for your child’s conduct, agree to follow health and safety guidelines, and indicate your preference regarding photo and media use. 

Locations are mostly in Montgomery County, MD.

Upon registration you will receive email reminders closer to the date you selected. Let's bless senior living residents in Montgomery County!

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Email *
Which date would you like to register for? *
Required
Type of school *
Parent/Guardian Information
Full Name 
Email Address
Phone Number
Child Information - Fill out for every child who will participate in the program.
Child’s Full Name and Age
 *
2 - Child’s Full Name and Age 
2 - Child’s Full Name and Age
3 - Child’s Full Name and Age
4 - Child’s Full Name and Age
5 - Child’s Full Name and Age
Health & Safety Commitment 
I agree not to send my child if they are showing signs of illness (such as fever, cough, sore throat, runny nose, vomiting, or diarrhea), to protect the vulnerable health of older adult residents. Do you agree to this statement?
 *
Volunteer Behavior Agreement

I give permission for my child to participate in the Grandkid Investigator Program at the senior living community. I understand that program staff and volunteers will provide general supervision during activities, but that I remain responsible for my child’s well-being and behavior. I release the organizers, facility, and staff from liability for any injury or incident that may occur.

 *
Photo & Media Release 
I give permission for my child’s photo, video, voice, or work (without using their last name) to be used in promotional materials for the Grandkid Investigator Program. Should you have any concerns please email thevalueofwrinkles@gmail.com. Select one:
 *
Commitment to Child Safety 
Please share any additional information about your child(ren) that will help us provide a safe and positive experience.
Additional Comments: Please leave any information about your child that would be helpful for us to know (special needs, allergies, etc). 
A copy of your responses will be emailed to the address you provided.
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