CAREGIVER CONSENT - Wildewood Community Association

WCA Member Name: *

Name of Child(ren) to be supervised: *

WCA Member Address *

Address Line 1

Address Line 2

City

State

Zip Code

HOA/Neighborhood (Orchid Park, Woodland, Hickory Nut...etc.) *

WCA Member Phone#: *

Emergency Phone#: *

Email *

Caregiver/Nanny Name *

First

Last

Caregiver Age: *

Caregiver/Nanny Phone#: *

I give permission for my caregiver to care for my children at the Wildewood Community Association Recreational Facilities without my supervision. I understand and agree that my permission granted hereby is at my/our sole risk. I understand and agree that Wildewood Community Association, its officers, trustees, employees, agents and volunteers shall not be liable for any direct, indirect, incidental, special, consequential, or exemplary damages resulting from the use of the Wildewood Community Association Recreational Facilities by my Caregiver or my children when unaccompanied to the facilities by me nor shall Wildewood Community Association be responsible for more than the responsibilities under its rules and regulations and by-laws. *

Date *