Protect Young Eyes - Childcare Registration
Monday, October 28th
6:15 pm - 8:45 pm
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Email *
Parent Name
Parent email *
Parent Cell Phone *
Secondary Emergency Name *
Secondary Contact Number *
Child 1 Name *
Child 1 Age *
Child 2 Name
Child 2 Age
Child 3 Name
Child 3 Age
Child 3 Name
Child 3 Age
I hereby acknowledge and record my independent and voluntary decision to allow my child to participate in the daily operations conducted by Valley Lutheran High School and related activities.  I understand that my child’s participation may entail certain anticipated and unanticipated risks regarding personal injury. I hereby acknowledge my voluntary and informed assumption on behalf of my child of full responsibility and liability regarding any injuries that the child may incur coincident to my participation in this activity.  I hereby assume any and all risks on behalf of my child associated with the activities offered by Valley Lutheran High School, and expressly waive, release, discharge and hold harmless Valley Lutheran High School, its servants, agents, employees, affiliates, and assigns from and against any and all liability for loss, damage, injury, illness or claim of any nature whatsoever, however caused, arising out of, in association with, nor related in any way to my or my child’s participation.   *
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