Preview Babysitting Liability Release Form

Babysitting Release Form

Parent’s Name: _________________________________________________

Child’s Name: __________________________________________________

Address:_______________________________________________________

Phone Number: ________________________________________

Cell Number: __________________________________________

In case of Emergency Contact: ____________________________________

Emergency Contact Number: ______________________________________

Allergies, physical ailments, any abnormalities we should be aware of, etc:

_________________________________________________________________

_______________________________________________________________________

________________________________________________________________________

I hereby accept any and all responsibility for and assume the risk of any and all injury or

damage to my person or dependent children which might arise directly or indirectly as a

result of, and a participation in the Academy Babysitting program. I hereby expressly

release discharge and hold harmless from any liability whatsoever the Academy and all

employees in their capacities as representatives of the Academy. I certify I am familiar

with the contents of this release. I have read and understand and it is my intention that by

signing this that the same be binding on me and my heirs, administrators, executors and

assignees.

_________________________________________ _______________

Signed by parent or legal guardian Date

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