WPD Youth Waiver | City of Wooster Ohio

CITY OF WOOSTER POLICE Child Participation Agreement and Waiver of Liability

Today's Date

First Name

Last Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Date of Birth

Age

Gender

Grade

School

If other, please specify

Parent/Guardian's Name

Primary Phone

E-Mail

2nd Emergency Contact Name

2nd Emergency Contact Phone

2nd Emergency Contact Relationship

Medical Information (current conditions, medications, allergies, etc...)

Agreement, Waiver, and Release of Liability

I do hereby acknowledge that I, or my child, participate voluntarily in the programs and events sponsored by the City of Wooster, Police Department, Recreation Department and any businesses and organizations associated. I declare that my health and physical condition, or that of my child, is adequate to meet the requirement of the program. I covenant and agree to indemnify and hold harmless the City of Wooster and its representatives, instructors and volunteers against and from any and all costs, damages, or expense arising from any accident or other occurrence causing injury to myself, my child or any other person or property during participation in this program. By registering for, participating in or attending any City of Wooster program or event, you agree to allow publication of any photos taken at any program, event or facility in the City of Wooster.

Signature