South Iredell High School Path and Peer
Email: sihspathpeer@gmail.com
PRE-REGISTRATION & PARENTAL WAIVER FORM
Parents Morning Out
December 10th, 2011 8 a.m. – 2 p.m.
Grades K – 5th
Email this pre-registration form to sihspathpeer@gmail.com or bring the day of to the sign in
table
Child’s
Name________________________________Grade_________________________
Boy ___ Girl___
Home Phone Number_______________________________
Email Address
__________________________________________________________________
Parent/Guardian
Name______________________________________________________________
____
Medical or other information we need to know, please include any food
allergies:__________________
__________________________________________________________________
In the event of any emergency, what is your location and phone number during PMO?
__________________________________________________________________
____________________
Phone _________________________
In the event of an emergency, whom can we contact , if we cannot reach you?
__________________________________________________________________
_____________________
Phone _________________________
PARENTAL RELEASE FORM I, the parent/guardian of this registered child hereby give
permission for him/her to participate in Parents Morning Out. I consent to his/her participation
in the activities planned for this event and certify that he/she is physically able to engage in the
event. I hereby grant to the leader in charge of the group the right to make emergency medical
decisions for my child in the event I cannot be reached. I understand I/we release and forever
discharge South Iredell Path and Peer, and adult chaperones from any and all claims, demands,
actions, or causes of action, past, present or future arising out of any damage or injury while
participating in this event. I am at least 18 years of age, I understand the above statement and
am competent and to execute this agreement.
PARENT/GUARDIAN SIGNATURE _______________________________________
PRINT NAME________________________________________________________
DATE __________