Event Name *

First Name

Last Name

Event Date *

MM

DD

YYYY

Date of Birth *

MM

DD

YYYY

Mother's Cell #

(###)

###

####

Father's Cell #

(###)

###

####

Emergency Contact Phone # *

(###)

###

####

Any physical/emotional diagnosis or restrictions that may inhibit your child from participating in our program *

Yes

No

Dietary Restrictions *

Yes

No

Allergies *

Yes

No

Custody Situations *

Yes

No

Diapers *

Yes

No

Breast fed *

Yes

No

Bottle fed *

Yes

No

PLEASE READ CAREFULLY. Release signatures to be obtained at time of child drop-off.: In consideration of the previously-declared child to participate in In a Pinch Subs LLC activities, while on the premises and property of this event location during the above mentioned date, the undersigned, for themselves and / or being the legal acting guardian of participant acting for themselves and on behalf of the participant, release and hold harmless In A Pinch Subs LLC, an Idaho LLC, its owners, officers, employees, and agents of and from any and all liability, claims, demands, and causes of action whatsoever, arising out of or related to any loss, damage, or injury, including death, that may be sustained by the participant and/or undersigned, while in or upon the premises upon which In a Pinch Subs LLC is conducting business, or any premises under the control and supervision of In A Pinch Subs LLC, its owners, officers, employees, or agents or in route to or from any said premises or place where activities are sponsored by In a Pinch Subs LLC, its owners, officers, agents, or employees. The corporation shall carry insurance on the participants in its care, however, the existence of insurance shall not change, alter, or increase the liability of In A Pinch Subs, LLC to the participant and the undersigned or affect the terms of this Release. In signing this release, the undersigned acknowledges A) That he or she has read thoroughly and understands completely, the terms of Registration and Release and signs it voluntarily B) That the undersigned signing either for themselves or as Legal Guardian is, in fact, the true and legal guardian and has the consent of the participant *

I Agree