Waiver Form | Mindwise Kids

Parent first name

Parent last name

Phone

Student first name

Student last name

Student birthday

Month

Day

Year

Student grade- fall 2025

If I cannot be reached in the event of an emergency, the following person is authorized to act on my behalf:

Emergency contact phone number

I waive and release Mindwise Kids and/or any and all agents associated with these activities against any and all liability judgments or demands for damages arising as a result of injuries or activities that take place while the applicant is enrolled.

Yes

I hereby give permission to Mindwise Kids to photograph, video and/or audio record my child and/or me and consent to the use of such materials for all promotional uses, including Internet use.

Yes

I agree that I am solely responsible for any items my child brings. If any items are lost or damaged, I agree that it is my sole responsibility, and not the responsibility of Mindwise Kids, or any of its agents to replace or reimburse me for lost items.

Yes

I have read the Waiver: Liability, Waiver: Photo/Video/Audio Recording, and Waiver: Personal Property information above and agree to the terms as noted. Signed (**Parent/Guardian digital signature)

Signature field is empty.