Babysitting Class 101 Registration Form
Putnam County Health Department March 9, 2023 9:00 am to 2:00 pm
Child's Name
*
First Name
Last Name
Parent/Guardian Name
*
First Name
Last Name
Age of the Child
*
Parent/Guardian Phone Number
*
Emergency Contact
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Does your child have any food allergies or need accommodations for lunch?
*
No
Yes
If yes, please specify below.
I recognize that the activity for which I am registering my child (participant) involves a risk of injury, as does any activity. I waive and release any and all rights and claims for injury or damages resulting from this event and agree to hold harmless the sponsors of this event for any and all injuries suffered by my child while participating in this activity unless such injury is caused by the gross negligence of the sponsoring agencies.
*
Yes
I give my permission for the Putnam County Health Department to photograph my child participating in the class. I understand that my child’s photo and first name may be published in the newspaper or used for other press releases.
*
No
Yes
Please give details
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