Assumption of Risk *

I hereby freely accept and fully assume all risks, dangers, and hazards and the possibility of personal injury, death, property damage, or loss arising out of, associated with or relating to my or my child’s attendance at or participation in any programs or activities provided by Gathering Wild Inc whether on the premises of Gathering Wild or off-site. I agree that if Gathering Wild Inc, in its sole discretion and on my behalf or on the behalf of my child, should secure any medical advice or services as it may deem necessary for my or my child’s health and safety, that I shall be financially responsible for such medical advice or services.

I Agree

I Do Not Agree

Release of Liability *

I agree that this Waiver and Release of Liability shall apply to each day I, or my child, are at Gathering Wild Inc regardless of the date that this form is signed below. I agree that I will assume the risk and full responsibility for any and all injuries, losses, or damages, that might occur to my child or other family members while on the premises (1043 Bathurst St) or participating in any off-site Gathering Wild Inc. program or activity; and to the maximum extent of the law, I agree to waive and release any and all claims, suits, or related causes of action against Gathering Wild Inc, their owners, officers, employees or agents for injury, loss, death, costs or other damages to me, my heirs or assigns, or third party claims, suits or related causes of action asserted against Gathering Wild Inc. arising from my conduct and/or my family’s conduct while participating in the preschool’s programs or activities. I further agree to release, indemnify, defend and hold Gathering Wild Inc harmless from any liability whatsoever for future claims presented by my child for any injuries, losses, or damages.

I Agree

I Do Not Agree

Photo Release *

I agree to give Gathering Wild Inc permission to take and use photographs or videos of my child while attending the program.

I Agree

Face

Body

Body (No Face)

I Do Not Agree

Acknowledge *

I acknowledge that I have read and understood the above terms.

I Agree

I Do Not Agree

Name *

First Name

Last Name

Child's Name *

First Name

Last Name

Phone *

(###)

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Child's DOB *

MM

DD

YYYY

Emergency Contact Name (1) *

In the event of an emergency, Gathering Wild Inc will contact the following primary emergency contact.

First Name

Last Name

Emergency Contact (1) Phone Number *

(###)

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Emergency Contact Name (2)

In the event the Primary emergency contact is unavailable, Gathering Wild Inc will contact the following alternative emergency contact.

First Name

Last Name

Emergency Contact (2) Phone Number

(###)

###

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For Birthday Parties Only

What is the date of the birthday party you are attending?

MM

DD

YYYY