Living Out Loud Parental Consent Form

Living Out Loud Parental Consent Form
I voluntarily consent for my son/daughter to participate in the Living Out Loud for Teens Program offered by the Clark County Youth Shelter & Family Services, Inc.
Child's Information
Child's Full Name

First NameLast Name
Parent / Guardian's Information
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
The Clark County Youth Shelter & Family Services and its administration, employees and agents have my full, free and voluntary consent as the parent and/or legal guardian of (child's name entered above) to provide this service. I agree that the Clark County Youth Shelter and its members, employees and agents, both jointly and separately, are relieved of all liability, expressed or implied, which may result from this service. I further shall indemnify and hold harmless the Clark County Youth Shelter and its members, employees and agents from all claims, actions, damages, expenses, liabilities and judgments asserted, commenced or obtained against the Clark County Youth Shelter and its members, employees and agents which may result from my son/daughter’s participation in this service.
Parent / Guardian's Signature

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Enter Today's Date

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Date
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Child's Information