I give my child: ___________________________ permission to attend the program
__________________________ on _________________ from __________________.
I recognize that the program named above, shall be conducted for the entertainment and educational benefit of the
participating children and acknowledge that my child’s participation in the program is voluntary. I understand that unpaid
volunteers will help facilitate the program, and that these volunteers, like employees, have passed a basic State of
Colorado background check.
I am aware the libraries are a public facility, open to everyone, and that my child may be excused from the program to use
the bathroom facilities unsupervised.
My child is in good health and I give my permission for them to receive emergency medical treatment if needed by the
nearest medical facility.
Except in cases of gross negligence, I specifically agree to release and hold harmless the Arapahoe Libraries, its officers,
employees, volunteers, committees and Board of Trustees, from and against any and all liability, from responsibility of
accident or injury to the above named child while participating in activities, programs, or services provided. Further, I
agree to be responsible for any medical, health, or accident expenses that may occur.
In the event my child does not cooperate or refuses to comply with the patron code of conduct, I agree to immediately
return to the library to pick up my child from the program.
During this event, I can be reached at _______________________________ (phone)
_____________________________________________________________ (address)
If for some reason I cannot be reached, the following person is authorized to act on my behalf. This person is also
authorized to pick up my child from the program.
Phone: ______________________
Address: ________________________________
Relation: _____________________
Signature of Parent or Legal Guardian: ________________________________________
Date: __________________
Revised 4/25/16