SWP 561 - PBC Parks & Rec
COVID-19 - PBC Liability Form
I have read, understand and agree to the above information and terms regarding COVID-19. In providing my first and last name below, I am providing both ackowledgement and agreement, as well as my electronic signature in type my name below**
Date is automatically recorded upon submission
Last Name (Parent/Legal Guardian)
First Name (Parent/Legal Guardian)
Child 1 (Last Name, First Name)
Child 2 (Last Name, First Name)
Child 3 (Last Name, First Name)
Child 4(Last Name, First Name)
Child 5+ (Last Name, First Name) - List any additional children in this field
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