Walking Home Release Form

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CAMPER WALKING HOME CONSENT, RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND IMDEMNITY AGREEMENT CONSENT

I authorize and give consent to the [Insert Name] YMCA to release my child from Camp without parental supervision and hereby consent, acknowledge and allow my child to walk home from camp without parental or YMCA supervision. I acknowledge that my child is 12 years of age or older.


RELEASE and WAIVER OF CLAIMS

I, individually and/or on behalf of my minor child(ren), hereby release and hold [Insert Name] YMCA and their officers, trustees, employees, directors, volunteers, and/or others acting on their behalf harmless from negligence and any and all claims that I or my child may have arising from walking home from camp.

ASSUMPTION OF RISK

I, individually and/or on behalf of any minor child(ren), expressly and specifically assume any and all risk of injury, illness, death, or property damage resulting from allowing my child to walk home from camp.

YOU ASSUME THE RISKS

I, individually and on behalf of my minor child(ren), understand that walking home unsupervised may be dangerous. Once you sign, you are saying that you understand the risks involved and accept all of the risks.

INDEMNIFICATION

I, individually and on behalf of my minor child(ren) shall hereby defend and indemnify [Insert Name] YMCA and their officers, trustees, employees, directors, volunteers, and/or others acting on their behalf from any and all claims arising from allowing my child to walk home from camp.

DURATION

This release will remain in effect for the existing camp season and I agree that I will notify the YMCA in writing if I choose to revoke this authorization.


CAMPER INFORMATION

Camp Year:
Child’s Name:
Child’s Date of Birth:
Child’s Address:
Child’s Phone Number:
Comments:
(please note the specific dates this release applies for in the comments)

Parent or Guardian’s Daytime Number:
Second Phone Number:


SIGNATURE PAGE
BOTH PARENTS MUST SIGN

Parent or Guardians Printed Name:
Parent or Guardian’s Signature:
Date:

Parent or Guardians Printed Name:
Parent or Guardian’s Signature:
Date:

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