Kids' Care Release Form
Email address *
All parents of any child(ren) (under 18) that wish to receive babysitting/childcare must complete the following childcare release form before his/her child may receive care.
Child's Name *
Your answer
Child's Birthday *
MM
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DD
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YYYY
Child's Age *
Second Child's Name
Your answer
Second Child's Birthday
MM
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DD
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YYYY
Second Child's Age
Third Child's Name
MM
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DD
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YYYY
Third Child's Birthday
Your answer
Third Child's Age
Personal Information
Main Parent/Guardian Name *
Your answer
Main Parent/Guardian Phone Number *
Your answer
Emergency / Pick-up Information
Authorized persons, other than parents/guardians listed above, who may be called in an emergency and/or pick up the child from the program. Only authorized individuals listed will be permitted to sign a child out. Anyone picking up a child (including parents) must be prepared to show a valid, State issued, photo ID. Minimum age for an authorized individual is 18 years old.
Name *
Your answer
Relationship *
Your answer
Phone Number *
Your answer
Name
Your answer
Relationship
Your answer
Phone Number
Your answer
Please list anyone that DOES NOT have authorization to pick up your child:
Name
Your answer
Relationship
Your answer
Phone Number
Your answer
RELEASE/DISCLAIMER
RELEASE/DISCLAIMER

In consideration of the babysitting/childcare services offered by , Studio Three to the child(ren) referenced above, the undersigned hereby waive, relieve, and discharge any and all claims which the undersigned may have, or claim to have, or in the future have, against Studio Three for all personal injuries or claims of any kind or nature known or unknown, caused by or arising out of babysitting/childcare services provided by Releasees, its agents, and employees.

This Release is intended to discharge in advance the Releasees from and against any and all liability arising out of or connected in any way to the use by the undersigned of the babysitting/childcare services provided at no charge by Releasees, even though that liability may arise out of negligence on the part of the Releasees.

The undersigned further understands that personal injuries occasionally occur to children while in the care of others, but knowing of such risk and in consideration of the services provided, the undersigned hereby agrees to assume those risks and to release, indemnify Releasee for all expenses, including attorney costs and fees and hold harmless the Releasees even though, through negligence or carelessness, they might otherwise be liable to the undersigned for damages.

It is further understood that this waiver, release, and assumption of risk is to be binding on the undersigned’s heirs and assigns.

I HAVE READ AND FULLY UNDERSTAND THE ABOVE RELEASE/WAIVER AND FULLY UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS
BY SIGNING THIS WAIVER VOLUNTARILY. PARENTS OR GUARDIANS MUST SIGN IF APPLICANT IS UNDER 18.

E-Signature *
Your answer
Date *
MM
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DD
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YYYY
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