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Home
Our Impact
Testimonials & Community
Programs and Services
Referral Form
Youth Leadership Permission Slip
Events
Volunteer
Resources
Blog
Contact Us
Youth Leadership Permission Slip
I give
Name
(Required)
First
Last
permission to attend
Activity
(Required)
with the NLBDC Youth Program.
I/We understand all reasonable safety precautions will be taken at all times by No Longer Bound Development Center and its agents during the events and activities. I/We authorize any treatment by an accredited hospital and/or physician deemed necessary for the subject of the release in case of an emergency. I/We understand the possibility of unforeseen hazards and know the inherent possibility of risk. I/We agree not to hold No Longer Bound Development Center Inc. its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by the subject of this form.
Parent/Guardian Name:
(Required)
First
Last
Signature
(Required)
Please use your finger or mouse to sign below
Email
(Required)
Emergency Contact
(Required)
First
Phone
(Required)
Additional Emergency Contact
First
Phone
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.
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