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Climb Tulsa

Child Care Waiver, Release of Liability, and Parental Consent Form


I/We, the undersigned, are the parents or legal guardians of the below named child or children and I/we agree, in taking advantage of child care services provided by Climb Tulsa, to release, waive, forever discharge and hold harmless Climb Tulsa and its owners, directors, officers, employees, managers, volunteers, contractors, staff and agents (the “Released Parties”) from and against any and all claims, demands, causes of action, damages, expenses, losses and liabilities (including attorneys’ fees and costs), in connection with or arising out of the child care services, including, but not limited to, bodily harm or injury to my/our children, or other loss CAUSED BY THE NEGLIGENCE OF ONE OR MORE OF THE RELEASED PARTIES, except only for loss, harms or injury occasioned by gross negligence or intentional misconduct by Climb Tulsa and/or its officers, agents, employees and volunteers. 

I understand that during the provisioning of child care services, there may be photos or video taken which may purposely or inadvertently include my/our children. By allowing my/our children to participate in the child care services, I agree to let Climb Tulsa use my/our children’s likeness, with or without my children’s names and without compensation to me/us or my/our children, in photos/videos for marketing or any other promotional purposes, including online media, and I/we expressly waive any right of privacy, copyright, compensation or other ownership right which may be connected to same.

This Agreement will be governed by the laws of the State of Oklahoma. Any legal action arising under this Agreement shall be brought exclusively under the jurisdiction and venue of the appropriate state or federal courts within or for the City and County of Tulsa, Oklahoma. If any portion of this agreement is deemed invalid or unenforceable by a court of competent jurisdiction, the remainder of the agreement shall remain in full force and effect. This agreement shall be binding on me/us and my/our heirs, next of kin, personal representatives, executors and administrators.

I/We grant permission and full authority for Climb Tulsa personnel or volunteers to take whatever actions they deem necessary regarding my/our child’s health and safety in the event I/we cannot be reached or in the situation where time is of the essence; and fully release Climb Tulsa personnel and volunteers from any liability in connection with those decisions. I/We grant permission for emergency treatment by a rescue team, private physician and/or hospital emergency health care facility staff, if needed. I/We acknowledge that Climb Tulsa will take any such action in the best interest of my/our child and Climb Tulsa will report such action to me/us as soon as possible.



First Parent/Guardian Name
First Name*
Middle Name
Last Name*
First Parent/Guardian Date of Birth*
Date of Birth
First Parent/Guardian Signature*
Second Parent/Guardian Name
First Name*
Middle Name
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Third Parent/Guardian Name
First Name*
Middle Name
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Fourth Parent/Guardian Name
First Name*
Middle Name
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Fifth Parent/Guardian Name
First Name*
Middle Name
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Sixth Parent/Guardian Name
First Name*
Middle Name
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Seventh Parent/Guardian Name
First Name*
Middle Name
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Eighth Parent/Guardian Name
First Name*
Middle Name
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Ninth Parent/Guardian Name
First Name*
Middle Name
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Tenth Parent/Guardian Name
First Name*
Middle Name
Last Name*
Parent/Guardian Date of Birth*
Date of Birth
Parent/Guardian's Email Address
Email*
Confirm Email*
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Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent/Guardian's Name
First Name*
Middle Name
Last Name*
Relationship*
Phone*
Parent/Guardian's Date of Birth*
Date of Birth
Parent/Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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