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Corporate Kids Events, Inc

Events Consent and Release Form

An award winning company with over 20 years experience

11276 Edward Dr, Grass Valley, CA 95949 • tel 800-757-3580

Our policy requires that our records are accurate and up-to-date. We do not share or sell this information.

In the event of an emergency, I hereby authorize any and all medical attention to be administered, to my child (children) as is deemed necessary by an attending physician or nurse. I understand and agree that I am financially responsible for any care so provided. In consideration of the opportunity to have my child (children) participate in the activities sponsored by Corporate Kids Events, Inc., I hereby assume all risks and waive all claims against the corporation, its respective officers, directors, employees, agents and representatives for bodily injury or death and for damage to or loss of any property directly or indirectly arising from or in connection with any activities involving Corporate Kids Events, Inc. except to the extent directly and solely caused by the willful misconduct of the corporation or its agents. I also understand and agree that management reserves the right to decline or discontinue enrollment based upon the management’s assessment of physical disabilities or medical conditions requiring an amount of attention or medical expertise beyond the company’s formal scope of ability. Corporate Kids Events has my permission to take photos of my family and children at this event. Pictures may be used for digital photo CD and/or customer access via our website homepage and for client and promotion for future events. Corporate Kids Events has my permission to take my child from the childcare room with supervision to use the bathroom, participate in a group game, or take a walk in the hotel, convention center, armory, or event location.

EVENT PERMISSION

Signature of Parent: 

September 7, 2024

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Information
Gender:*
Female
Male
Transgender
Non-binary/Non-Conforming
Prefer Not To Respond
Other

If other, please specify

Chronic Illnesses

Food Restrictions

Special Needs

Allergies

Insurance Carrier

Current medications

Other Instructions
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Gender:*
Female
Male
Transgender
Non-binary/Non-Conforming
Prefer Not To Respond
Other

If other, please specify

Chronic Illnesses

Food Restrictions

Special Needs

Allergies

Insurance Carrier

Current medications

Other Instructions
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Gender:*
Female
Male
Transgender
Non-binary/Non-Conforming
Prefer Not To Respond
Other

If other, please specify

Chronic Illnesses

Food Restrictions

Special Needs

Allergies

Insurance Carrier

Current medications

Other Instructions
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Gender:*
Female
Male
Transgender
Non-binary/Non-Conforming
Prefer Not To Respond
Other

If other, please specify

Chronic Illnesses

Food Restrictions

Special Needs

Allergies

Insurance Carrier

Current medications

Other Instructions
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Gender:*
Female
Male
Transgender
Non-binary/Non-Conforming
Prefer Not To Respond
Other

If other, please specify

Chronic Illnesses

Food Restrictions

Special Needs

Allergies

Insurance Carrier

Current medications

Other Instructions
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Gender:*
Female
Male
Transgender
Non-binary/Non-Conforming
Prefer Not To Respond
Other

If other, please specify

Chronic Illnesses

Food Restrictions

Special Needs

Allergies

Insurance Carrier

Current medications

Other Instructions
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Gender:*
Female
Male
Transgender
Non-binary/Non-Conforming
Prefer Not To Respond
Other

If other, please specify

Chronic Illnesses

Food Restrictions

Special Needs

Allergies

Insurance Carrier

Current medications

Other Instructions
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Gender:*
Female
Male
Transgender
Non-binary/Non-Conforming
Prefer Not To Respond
Other

If other, please specify

Chronic Illnesses

Food Restrictions

Special Needs

Allergies

Insurance Carrier

Current medications

Other Instructions
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Gender:*
Female
Male
Transgender
Non-binary/Non-Conforming
Prefer Not To Respond
Other

If other, please specify

Chronic Illnesses

Food Restrictions

Special Needs

Allergies

Insurance Carrier

Current medications

Other Instructions
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Gender:*
Female
Male
Transgender
Non-binary/Non-Conforming
Prefer Not To Respond
Other

If other, please specify

Chronic Illnesses

Food Restrictions

Special Needs

Allergies

Insurance Carrier

Current medications

Other Instructions
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Off-Site Field Trip Options
My child has permission to attend all off-site field trips.*
No
Yes

Name of Event:
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 or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information
Gender:*
Female
Male
Transgender
Non-binary/Non-Conforming
Prefer Not To Respond
Other

If other, please specify

Chronic Illnesses

Food Restrictions

Special Needs

Allergies

Insurance Carrier

Current medications

Other Instructions
Parent or 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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