Gals Institute in Delafield WI

Gals Institute Group Waiver

* Indicates required field

Workshop Name *

School Name or Troop # (If applicable) *

Participant Name *

First

Last

Age *

RELEASE OF LIABILITY AGREEMENT:
In consideration of the acceptance of my (child) participation in the Gals Institute event. I (and my child, if I am signing as parent or guardian) release Gals Institute, the facilitators, and members of the aforementioned, The Gals Institute, respective employees and agents and all workshop volunteers, promoters and sponsors from any liability or claim for injury or illness that my child may sustain during my child’s participation in this event. I understand that this release applies to myself (or my child) and my (or my child’s) personal representatives, heirs and assigns.

RELEASE OF LIABILITY AGREEMENT *

Yes, I Agree to the Release of Liability

PHOTOGRAPHY WAIVER *

I approve that my child can be photographed by Gals on the Go Project staff so it may be used for marketing and promotion of other events. These events may also be used on Media promotion. Please do not photograph my child.

Parent / Guardian Digital Signature *

First

Last

Phone Number *

Does the participant have any allergies? *

No Yes (please indicate below)

Does the participant take medication? *

No Yes (please indicate below)

Allergies *

Medications currently taking *

Any special needs or behavioral concerns we need to be aware of for your child? *

Choose One *

Please add me to your mailing list so I may hear about other Gals Institute Events I agree to complete a workshop survey to assist in the improvement of events and to share data so that donations can be raised to provide future programs at no cost

Email *

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