Clone of August 23rd Parents Night Out Babysitting 5-8pm

Parents Night Out Babysitting May 2nd 5-8pm (9:30 option)

Give yourself a well-deserved break while your kids play at The Backyard! Drop off your kids for an evening of fun, games, and exercise all supervised by our trusted staff and volunteers. Proceeds from this event will help The Backyard reach our goals to offer our indoor space to all. Imagine what you can do with those three kid-free hours included in your registration! Space is limited, so secure your spot today! Unfortunately, we can not offer refunds but can give you a receipt of donation if you can't make it. Child must be potty trained. Invite your friends! Thank you for your support—we can’t wait to see your kids at Parents Night Out!
Parent Name*

First NameLast Name
Parent Contact E-mail*
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Parent Contact Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Parent Contact Phone Number*
Phone Number
Child Name*

First NameLast Name
Age*
age
Child Name

First NameLast Name
Age
Age
Child Name

First NameLast Name
Age
Age
Informed Consent and Acknowledgement

I hereby give my approval for my child’s or children's participation in any and all activities prepared by The Backyard Whidbey during the selected camp. In exchange for the acceptance of said child(ren)’s candidacy by The Backyard Whidbey. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless The Backyard Whidbey. and all its respective officers, agents, and representatives from any and all liability for injuries to said child(ren) arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child(ren), I hereby waive all claims against The Backyard Whidbey . including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Medical Release and Authorization

As Parent and/or Guardian of the named athletes, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the The Backyard Whidbey . and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Parent Signature

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