Program Waiver
Please complete this form in its entirety. Must be updated annually. The Trailhead appreciates your support!
Enrollment Date *
MM
/
DD
/
YYYY
Child's Name *
Child's Date of Birth *
MM
/
DD
/
YYYY
Age *
Allergies/Health Conditions/Other Concerns *
Medications *
All medications must be in original packaging with label. Prescription medications must include doctor's prescription and pharmaceutical label. Please include written administration schedule or circumstances.
Child #2 Full Name
First,Last
Child's #2 Date of Birth
MM
/
DD
/
YYYY
Child #2 Age
Allergies/Health Conditions/Other Concerns #2
Medications #2
All medications must be in original packaging with label. Prescription medications must include doctor's prescription and pharmaceutical label. Please include written administration schedule or circumstances.
Preferred Hospital *
Hospital Address *
Hospital Phone *
Preferred Physician *
Physician Address *
Physician Phone *
Payment Form *
Cancellation Policy: 3 days noticed is required for any cancellations. If cancellation is less than 3 days from program/camp/class/drop off no refund will be given. If the program requires a minimum number of participants to run (noted on product description) no refund will be given if you cancel. A participant absence is not transferable to another date and no refunds are given due to unplanned absence or late cancellation.
Required
Parent #1 Full Name *
First, Last
Best Phone Number to Reach Parent #1 *
Mailing Address Children/Parent #1 *
Physical Address Children/Parent #1
Email Parent #1 *
Parent's #1 Employer
#1 Employer Address
#1 Employer Phone
Parent #2 Full Name
First, Last
Best Phone Number to Reach Parent #2
Mailing Address Parent #2
Parent's #2 Employer
Employer Phone #2
Employer Address #2
Emergency Contact #1 *
Emergency Contact #1 Phone # *
Emergency Contact #1 Address *
Emergency Contact #2 - MUST FILL OUT TWO EMERGENCY CONTACTS! *
Emergency Contact#2 Phone # *
Emergency Contact #2 Address *
Persons Authorized For Pick-up #1: Name, Address, Phone Number *
Persons Authorized For Pick-up #2: Name, Address, Phone Number *
Persons Authorized For Pick-up #3: Name, Address, Phone Number *
Persons Authorized For Pick-up #4: Name, Address, Phone Number *
I authorize The Trailhead to use electronic media (TVs, Computers, Handheld Devices, etc.) as a teaching aide. *
Authorization for child to check himself/herself in or out of Trailhead Programming. (check box for signature) *
Required
Member *
Please read the Parent Agreement and click "I agree". *
Thank you for your understanding and adhering to our policies!
Required
Parent Agreement
I am interested in volunteering for The Trailhead
This Waiver is valid for ONE YEAR from date of submission. If any information changes, please fill out a new form, email info@trailheadkids.org with changes, or call us at (970) 349-7160. Thank you!
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