Liability Waiver Please read, check, and sign the liability waiver. Healthy Communities of Southern Inyo County, Lone Pine Unified School District and Owens Valley Unified School District and its instructors are NOT LIABLE for personal injuries, loss or damage of personal property. I have read, understand and accept the conditions of the Healthy Communities of Southern Inyo County, Lone Pine Unified School District and Owens Valley Unified School District liability release. I agree to release and hold harmless Healthy Communities of Southern Inyo County, Lone Pine Unified School District and Owens Valley Unified School District and their instructors or supervisors for any and all claims, losses and suits. Parent Signature Parent Full Name Date Child's Info Child's First Name Child's Last Name Child's Date of Birth Phone Street Address City Zip Emergency Contacts Mom's Full Name Mom's Cell Phone Mom's Home Phone Mom's Work Phone Dad's Full Name Dad's Cell Phone Dad's Home Phone Dad's Work Phone Other Contact's Full Name Other Contact's Cell Phone Other Contact's Home Phone Other Contact's Work Phone Δ
