Conference Childcare

Your Name *

Your Email *

Your Cell Phone *

Other Parent's Name (optional)

Other Parent's Cell Phone (optional)

Emergency Contact Name (friend or family) *

Emergency Contact Cell Phone *

In the event of an emergency, I hereby authorize any and all medical attention to be administered to my child (children) as is deemed necessary by an attending physician or nurse. I understand and agree that I am financially responsible for any care so provided. In consideration of the opportunity to have my child (children) participate in the activities sponsored by Corporate Kids Events, Inc., I hereby assume all risks and waive all claims against the corporation, it’s respective officers, director, employees, agents and representatives for bodily injury, illness, or death and for damage to or loss of any property directly or indirectly arising from or in connection with any activities involving Corporate Kids Events, Inc. except to the extent directly and solely caused by the willful misconduct of the corporation or its agents. I also understand and agree that management reserves the right to decline or discontinue enrollment based upon the management’s assessment of physical disabilities, illness, or medical conditions requiring an amount of attention or medical expertise beyond the company’s formal scope of ability. Corporate Kids Events has my permission to take photos of my family and children at this event. Pictures may be used for digital photo CD and/or customer access via our website homepage and for client and promotion for future events. Corporate Kids Events has my permission to take my child from the childcare room with supervision to use the bathroom, participate in a group game, or take a walk in the hotel, convention center, armory, or event location. *

I consent to my submitted data being collected and stored as outlined by the site Privacy Policy.