Child & Release From Liability Form

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A Program of Andrew Fleck Child Care Services CONSENT TO CHILD CARE AND RELEASE FROM LIABILITY FORM I/We representative(s) of (name of the child/ren) hereby agree to, assume responsibility for and undertake to abide by the arrangements with the STCC Program for childcare to be provided by the designated caregiver(s) (hereinafter referred to as STCC caregiver) of the STCC Program, to take place during the conference/ special event at (name of location of conference/special event) under the following conditions: That I/We 1.. I/We further agree that the expense resulting from such a decision by the STCC caregiver to seek emergency care, (including but not limited to ambulance bills, doctor s fees and hospital charges), will be my/our sole responsibility and hereby agree to hold the STCC caregiver and the STCC Program harmless from same..


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