Parental Insurance Waiver
I (We) do not wish to enroll our child(ren) in the Student Accident Insurance Program offered through the school.
Parent Signature
I have agreed to submit this waiver by electronic means. I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature. * By typing my name below, I am electronically signing my waiver.
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Your answer
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Child First Name *
Your answer
Child Last Name *
Your answer
2nd Child First Name
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2nd Child Last Name
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3rd Child First Name
Your answer
3rd Child Last Name
Your answer
4th Child First Name
Your answer
4th Child Last Name
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5th Child First Name
Your answer
5th Child Last Name
Your answer
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