Activity Waiver & Consent Form

I give permission for my child to participate in a Verbs Inc. Education in-person outing at Jacobsburg Environmental Education Center on

Friday, May 1st, from 10:00 AM to 2:00 PM.

Activities include a supervised hike, creek exploration, and outdoor picnic.

I understand that participation in outdoor activities involves inherent risks, including but not limited to:

Name

This field is for validation purposes and should be left unchanged.

Participant (Child Attending)(Required)

First Last

Parent/Guardian(Required)

First Last

Does your child have any medical conditions we should be aware of in an emergency?

Yes

Allergies / Medical Notes

Please list any allergies, dietary restrictions, medical conditions, or other relevant information:

Emergency Contact(Required)

First Last

Phone Number(Required)

Phone Number of Emergency Contact

Acknowledgement & Signature(Required)

By typing my name below, I acknowledge that I have read and agreed to this waiver.

info@verbsinc.com

908-291-7823

908-291-7823