SHOW ME Group Consent 

Date of First SHOW ME Group *
Date of First SHOW ME Group
Name *
Name
Gender *
Parent/Caregiver's Name *
Parent/Caregiver's Name
Phone *
Phone
Which location are you attending? *
How did you hear about SHOW ME group? *
Consent for Pictures/Video *
Your initials give Pediatric Interactions Inc. consent to photograph and/or videotape your child’s session(s) and to utilize your child’s photograph and/or videotape for the following purpose(s):
Release Form

Release Form 

I fully understand that Pediatric Interactions Inc. will not accept responsibility for injuries sustained by any child during the course of drop in play group program (“Program”).  I also understand that it is the parent’s responsibility to explain to the child about “Safety First” measures, according to what the parent feels is appropriate. 

I hereby release, waive, discharge and covenant not to sue Pediatric Interactions Inc. its officers, servants, agents, independent contractors, and employees ("releasees") from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or relating to any loss, damage, injury or death that may be sustained by my Child(ren) (named above), whether caused by the negligence of the releasees, or otherwise, while participating in the Program, or while in, on or upon the premises where the Program is being conducted, while in transit to or from the premises, or in any place or places connected with the Program.

I further hereby agree to indemnify and save and hold harmless the releasees and each of them, from any loss, liability, damage or costs they may incur due to my Child(ren)’s participation in the Program, whether caused by the negligence of any or all of the releasees, or otherwise.

In signing this release, I acknowledge and represent that: I have read the foregoing release, understand it, and sign it voluntarily as my own free act and deed; No oral representation, statements or inducements, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age and fully competent and the parent or legal guardian of the Child(ren) ; and I execute this Release for full, adequate and complete consideration fully intending to be bound by same.