Parents' Night Out-Resigration Form
Saturday, February 10, 5 to 10 PM at St. Paul's Lutheran Church, Ardmore. Fundraiser hosted by the youth group of St. Paul's to help defray costs to attend the ELCA National Youth Gathering in Houston, Texas, June 27 - July 1. Pizza, snacks and drinks provided. Cost: $20 per child or $30 per family. Thank you for your support! Kindly complete Hold Harmless and Waiver/Release for Babysitting Services form below to expedite the drop-off process.
Name of Parent/Guardian *
Your answer
Phone(s) # *
Your answer
Allergy/medical concerns of any kind (if none, please write "none") *
Your answer
Child's Name/Age *
Your answer
Child's Name/Age
Your answer
Child's Name/Age
Your answer
Child's Name/Age
Your answer
By checking the box below, I agree am leaving my child/children with the babysitting service at St. Paul’s Evangelical Lutheran Church and hereby release and waive against all claim of St. Paul’s Evangelical Lutheran Church, its agents, employees, volunteers, representatives, officers, directors, from injuries, damages arising from injuries relating to my child or children’s participation at the babysitting at St. Paul’s Evangelical Lutheran Church. I further agree to indemnify, save and hold Indemnities harmless from any loss, liability, attorney fees, damage or cost that they (or any of them) may incur out of or related to the babysitting services offered by St. Paul’s Evangelical Lutheran Church whether St. Paul’s Evangelical Lutheran Church cause the negligence of the indemnities or otherwise. *
Required
Name of person completing this form/relationship to child/children: *
Your answer
E-Mail of person completing the form: *
Your answer
Date form completed: *
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