I hereby certify that I am the adult parent or guardian of a minor who is  ________  years old*, and I consent to his/her participation as a volunteer with Table One. I 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.

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.

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. Once this release form is signed, I understand that the Table One Board of Directors, Staff, and Affiliates are not liable or responsible for any personal injury, loss of property, negligent, willful or intentional act.

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 the premises at North Detroit Street in Kenton, Ohio and/or any Table One sponsored event.

Print Name ___________________________________________________________

Signature _______________________________________  Date _______________

Phone: (________) _____________________