Parental Consent & Waiver

I, __________________________, grant permission for my son/daughter, _______________________, to participate in the Bali Kids Tour activity,

This activity will take place under the guidance and direction of the Bali Kids Tour’s Staff and Tour Leader

I, as parent and/or legal guardian, remain legally responsible for any personal actions taken by the above named participant. I agree on behalf of myself, my child named herein, or our heirs, successors and assigns, to hold harmless and defend Bali Kids Tour, its officers, directors and agents, employees, faculty, or representatives associated with the event, from any and all actions, claims, demands, damages, costs, expenses and all consequential damage arising from or in connection with my child attending the event or in connection with any illness or injury or cost of medical treatment in connection therewith. In signing the Parental Consent and Waiver, I am not relying on any oral or written representation or statements made by Bali Kids Tour and, its officers, directors and agents, employees, or representatives associated with the event, to induce me to permit my child to take the trip, other than those set out in this Consent and Waiver.

I am 18 years of age or more and have read and understand the terms of this consent and waiver, and recognize that it is binding upon me, my heirs, executors and administrators.

 

 

(_______________________________)

Parent/Guardian over Printed Name

Date: _________________

Home Address: ____________________

Contact No(s): ___________________

 

(To be signed when we pick up your child.  Don’t worry about print out this document.  Our Chaperone will provide you with this document when we pick up your child(s).)

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