LBD Child Care Registration Form

Saturday, October 1, 6-9pm | Please fill out this form and click submit.
Guardian Information

 
 
 
Child Information

 
 
 
Release Statement

The Little Black Dress Event Child Care will provide special stories, activities, and treats for the children who attend. 

All child care workers have had background checks. 

In the unlikely event that any accidents occur, our team will contact the guardian but The Little Black Dress non profit organization will not be held responsible for such incidents. 

Checking the box below you certifies that you are the parent or legal guardian of the registered child and hereby give consent to have the minor child participate in the LBD Child Care at Renaissance Hotel and Convention Center on Saturday, October 1 from 6-9pm. 



In the unlikely event of any injury, the parent/guardian will hereby assume all risk of injury, harm, damage, or death to the minor child in connection with his/her participation in this activity.  



To the fullest extent permitted by law, as parent/guardian, checking this box below serves as your signature and releases The Little Black Dress Event, its leaders, directors, volunteers, and representatives from any injury, harm, damage or death which may occur to your minor child while participating in the LBD Child Care and agree to save and hold harmless The LIttle Black Dress Event,  its leaders, directors, volunteers, and representatives from any claims arising out of minor child’s participation in the event.

Checking the box below affirms your understanding of being responsible for the health care of the minor child and that your insurance plan is to pay for the medical, dental, or hospital care or treatment that is given to the minor child.


 

Please select all that apply.

Description

Saturday, October 1, 6-9pm
Please fill out this form and click submit.