General Information

  • Please fill in the child's full address.

  • Please fill in the parent's full address.

 

Additional Information

  • I, the undersigned, intending to be legally bound for myself and on behalf of my child, as well as, my heirs, and personal representatives do hereby indemnify, release and discharge Dayspring, Inc., its representatives, employees, contractors, volunteers, and successors and assigns (herein after called “Indemnities”), from any and all liability for injuries, death or damages and from any and all loss, claim, or injuries to my child or to my property, of any kind, arising in any way out of my child’s participation in this program. My child has permission to walk home from the program facility, if so indicated by me on the registration form. I agree that I will defend, indemnify and hold harmless each and every one of the Indemnities against all claims, demands and causes of action including court costs and attorney’s fees directly or indirectly from any action or other proceeding arising in any way from participation by my child in the program. This indemnity, waiver release extends to all claims whether foreseen, unforeseen, known or unknown. I have full knowledge of the risks involved in this program. I hereby authorize medical treatment, at my expense, for my child in the event of an injury or illness during the program. I acknowledge that Dayspring, Inc. provides no insurance protecting my child. If pictures are taken during the program, I authorize the use of these photos for publicity purposes.
 

Verification