EVENT: I Can! Girls Conference
DATE: October 12, 2019

Note: The Release Waiver must be filled for every girl attending.

Please read the follow, then fill out and electronically sign the form below.

Waiver of Liability, Release & Indemnity Agreement Notice: This is a legally binding agreement. I understand that by signing this Waiver of Liability, I release and hold harmless Women’s Journey Foundation (WJF), and its owners, directors, officers, advisors, employees, agents, instructors, volunteers, childcare workers and all other persons or entities acting for them from any and all claims, demands, suits, cost and charges, in connection with or arising out of WJF’s program service, including but not limited to, personal injury, bodily harm, injury or property damage occurring while the below child is in the care of WJF.

I hereby grant permission to WJF and its staff full authority to take whatever actions they deem necessary regarding my child’s health and safety in the event I cannot be reached or in the situation where time is of the essence; and fully release WJF and its staff from any liability in connection with those decisions. I grant permission for emergency treatment by a registered nurse, hospital or emergency health care facility staff if needed. Any such action will be taken in the best interest of my child and will be reported to me as soon as possible.

  1. Children attending the program may be dropped off at 9am and must be picked up by the same parent/guardian/chaperone that dropped them off by 3:30 pm.
  2. Lunch, snacks and water will be provided for the children; please advise of allergies or medical conditions that may affect your child.
  3. Please leave a cell phone number below in case of emergency. A first aid kit and registered nurse will be on premise. In the event of an emergency we will contact 911 as well as the parent/guardian/chaperone.
  4. There will be filming of the event taking place, both video and still photography. I hereby grant free permission for The Women’s Journey Foundation to use images of my child participating in their programs or events for outreach purposes, including but not limited to: electronic or print materials and/or media. I understand that my child’s name will not appear with any photo of her.
  • I HAVE READ AND UNDERSTAND THIS ON-SITE CONSENT AND WAIVER FORM AND SIGN VOLUNTARILY AND ENTIRELY OF MY OWN FREE WILL.
  • This field is for validation purposes and should be left unchanged.