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Sponsored by: Pride and Joy Child Care

Child Care Waiver and Emergency Contact


Childs name____________________________________________________ age__________ DOB_______________________
Childs name____________________________________________________ age__________ DOB_______________________
Childs name____________________________________________________ age__________ DOB_______________________
Parents name___________________________________________________ Phone #__________________________________
Emergency Contact if parent cant be reached_____________________________________________________________
Phone # _________________________
Allergies___________________________________________________________________________________________________
Special notes regarding your child
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
I/we, the undersigned, are the parents(s)of the above named child/children agree in taking advantage of this
Pride and Joy child care Kids Korner service, while participating in the Nathan George Softball Classic. I agree
to pick up my child/children as soon as my softball game is over. The Nathan George Foundation, Pride and
Joy Child Care, and the employees/volunteers thereof shall not be held responsible for any injury, illness or other
affliction that may occur.
As part of this agreement I understand that pictures may be taken to be placed on the Nathan George
Foundation website.
Signature of parent_________________________________________________________ date__________/__________/2011
Team name________________________________________________________________________________________________

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