Table One

“One Table. Everyone Eats.”

 

Minor Volunteer Release and Waiver

 

I hereby certify that I am the adult parent or guardian of, a minor child who is ________ years old*, and I consent to his/her participation in a volunteer capacity with Table One. In the event of an emergency, I authorize the person in charge to seek qualified medical aid for any injury sustained by my child. I understand that all costs incurred for medical expenses are my

responsibility.

I also understand my child is expected to act in an appropriate manner. If  my child does not behave appropriately, I may be required to pick him/her up at the site. Once this release form is signed, I understand that the Table One Board of Directors, Staff, and Affiliates are not liable orresponsible for any personal injury, loss of property, negligent, willful or intentional act.

Additionally, I acknowledge that my son/daughter’s participation in volunteering with Table One is entirely voluntary and

understand that they are subject to the rules, procedures, and regulations of this organization.

Furthermore, I acknowledge that I have read and understand the above statements and that I am of legal age to bind myself to this release and waiver.

   *Any child under the age of sixteen must be supervised by an accompanying parent/guardian at all times.**This includes: a) the premises at North Detroit Street in Kenton, Ohio and/or any Table One sponsored event.

 

Please Print Clearly

 

Parent/Guardian Name: ____________________ _____________________

First                          Last

 

Address: ________________________ __________ _____ _________

Street                            City         State       Zip

 

Phone: (_____) _____-___________