WATER FIGHT 7/11/2014

Permission Form
Teens Name_____________________________
Any allergies in!l"#ing $oo#% &es No
I$ yes '(a) are )(ey% __________________________________________
_____________________________________________________________
Are yo" )a*ing any me#i!a)ion% &es No
I$ yes '(en #oes i) nee# )o +e )a*en% _______________________
,Please no)e )(a) all me#i!a)ion in!l"#ing o-er )(e !o"n)er m"s) +e gi-en )o
li+rary s)a$$ mem+er ".on arri-al/
I __________________________ "n#ers)an# )(a) I 'ill +e e0.e!)e# )o
.ar)i!i.a)e $ollo' r"les an# res.e!) )(e #e!isions o$ )(e 1aramie 2o"n)y 1i+rary
3 Pa"l 4mi)(s 2(il#ren 5illage s)a$$ mem+ers6 I $"r)(er "n#ers)an# )(a) $ail"re )o
#o so 'ill res"l) in a .(one !all )o my .aren)s an#/or I may +e as*e# )o lea-e6 I
also reali7e )(a) sin!e i) is a 8'a)er $ig()9 i$ I !(oose )o lea-e $or any reason I 'ill
no) +e a#mi))e# +a!* insi#e )(e Pa"l 4mi)(s 2(il#ren 5illage6
Please (a-e yo"r parents $ill in )(e in$orma)ion +elo':
I ______________________________ gi-e my .ermission $or my )een
______________________________ )o .ar)i!i.a)e in )(e 1214 Wa)er Fig()
;"ly 11
)(
2014 $rom <.m )o 4.m a) )(e Pa"l 4mi)(s 2(il#ren 5illage =1= 4
1ions Par* >r 2(eyenne W&6 I "n#ers)an# )(a) I am res.onsi+le $or my )eens
)rans.or)a)ion )o an# $rom )(e 2(il#rens 5illage as 'ell as any "ne0.e!)e# early
.i!* ".6 Teens m"s) +e .i!*e# ". +y 4:00 .m6 I also "n#ers)an# )(a) )(ere 'ill
+e .(ysi!al a!)i-i)y 'e) s"r$a!es 3 )(a) my !(il#ren 'ill ge) 'e)6
I gi-e )(e 1aramie 2o"n)y 1i+rary 4ys)em .ermission )o see* emergen!y me#i!al
!are $or my !(il# s(o"l# )(e nee# arise6
Name o$ Ins"ran!e 2om.any __________________________________
Name o$ Ins"re#: _________________________________
Poli!y n"m+er _____________________________
Please lis) a n"m+er '(ere yo" !an +e !on)a!)e#:
___________________________
OVER
In exchange for the opportunity to participate in the Laramie County
Library/Paul Smiths Chilren Village !ater "ight# all participants shall
unerta$e any an all ris$s% &he participant an/or his or her parent or
guarian shall be liable for any an all ris$s% &he Laramie County Library
System# its electe an appointe officials# employees an agents shall
not be liable for any in'uries or amages to any participant in the Laramie
County Library Systems !ater "ight# or the property of the participant# or
be sub'ect to any actions# causes of action# amages# claims or emans#
incluing (ithout limitation# those amages resulting from acts of
negligence on the part of the Laramie County Library System or Paul
Smiths Chilren Village ) its electe an appointe officials# employees
an agents% "urther# any participant# for himself/herself an on behalf of his
or her heirs# personal representati*es an assigns# oes hereby# fore*er
(ai*e# release an ischarge the Laramie County Library System# Paul
Smith Chilrens Village an its electe an appointe officials# its
employees an agents from all $no(n or un$no(n personal in'uries#
property amage or eath resulting or arising out of his or her participation
in Laramie County Library System/ Paul Smiths Chilren Village !ater
"ight
4igne# ______________________________ Paren) or 1egal G"ar#ian
I$ yo" (a-e any ?"es)ions or !on!erns .lease !all An#re' As?"i)( a) 77<@7201 or
email aas?"i)(A1214online6org6