Waiver | littlereadersacademy

Liability Waiver

Parent/Guardian First Name

Parent/Guardian Last Name

Date of Birth

Phone

Do the participants have any allergies or medical conditions we should be aware of?

Yes

Please list names, birthdates, and any allergies or medical conditions of children particiipating:

Signature

I declare that the info I’ve provided is accurate & complete

I hereby acknowledge this release from liability for accidental injury or illness which my child may incur as a result of participation in classes at Little Readers Academy. I hereby assume all risks connected therewith and consent to my child's participation in this program. I agree to disclose my child's physical limitations, disabilities, ailments, or impairments which may affect their ability to participate in this program.

Thanks for submitting!

“Play, learn, and grow together”

CALL/TEXT US: 1-801-310-8926

LITTLE
READERS
ACADEMY est. 2009

Liability Waiver