The PEAK Foundation
Consent to Participate Form

Event Start Time *
Event Start Time
Event End Time *
Event End Time
Child's Name *
Child's Name
Child's Name
Child's Name
Child's Name
Child's Name
Child's Name
Child's Name
I give my child/children permission to be picked up from the group activity by persons other than myself *
Code Word:
Name
Name
Name
Name
It is understood that a late charge of $1.00 per minute after scheduled event time (listed above) will be charged to ensure prompt pick up. *
I give The PEAK Foundation permission to use any event photos containing my child for The PEAK Foundation's promotional, website, and social media marketing. *
As a parent/guardian, I understand that The PEAK Foundation staff will do everything possible to prevent any injury or accident. However, I fully understand that participation in programs involves inherent risks associated with each activity. In consideration with the agreement to allow my child to participate in the referenced activities, I agree to accept responsibility for any loss, damage, or injury to my child that occurs during my child's participation in said activities, that is not the result of fraud, willful injury to person or property, or the willful neglect, violation of a law, by a trustee, employee, or agent of The PEAK Foundation. *
Parent/Guardian *
Parent/Guardian
Parent/Guardian
Parent/Guardian
Today's Date *
Today's Date
Phone *
Phone
Address *
Address
By clicking here, I hereby verify this information is correct and may be considered an electronic signature for filing purposes. *
Emergency Contact *
Emergency Contact
Phone Number *
Phone Number
Child's Primary Care Physician *
Child's Primary Care Physician
Phone 2 *
Phone 2
Checkbox 5 *
After this form is submitted, an on-screen prompt will appear with a link for payment options. I understand, and agree, that in order to get the pre-registration discount, payment must be online. Pre-registration prices do not apply on the evening of the event.