Permission Form

Today's Date:*

Child's Name

First

Last

Grade

Shirt Size

Gender*

Female

Male

Home Address

My Child Is Interested In Learning How To Play Golf*

Yes

Pickup Authorization

Other than than Parent(s), who is authorized to pick up your child daily, as well as from official Love Our Nation events (Must be 18 years of age or older.)

TERMS: By checking the "I Agree To The Terms" checkbox below, you agree and give permission for your child to participate in Love Our Nation programs from August 9, 2022 – August 30, 2023 including, transportation, field trips, excursions, camps, events, and to any emergency relocations), and release/indemnify Love Our Nation, its staff and volunteers, from any liability claims arising from child’s participation.

Love Our Nation Terms*

I Agree To The Terms

I Do Not Agree To The Terms

CONSENT: Love Our Nation will photograph/film the program activities listed above which will be posted on our website as well as social media. By selecting "I Consent" in the checkbox below, you consent to allowing Love Our Nation to publish your child’s picture on the internet, social media sites, and all other public relation material associated with the organization or the Earth 2 Table program.

Consent*

I Consent

I Do Not Consent

I agree to volunteer 1 day each month to LON program: *

Yes

Volunteering is mandatory. You must fulfill your monthly obligation on order for your child / children to remain in the program.

I Agree To Volunteer On These Days

Monday

Tuesday

Wednesday

Thursday

COVID-19 Liability Release Waiver

The World Health Organization has declared the novel Coronavirus (COVID-19) a worldwide pandemic. Due to its capacity to transmit from person-to-person through respiratory droplets, the government has set recommendations, guidelines, and some prohibitions which For The Love Our Nation Corp. adheres to comply.

COVID-19 Acknowledgement

In consideration of my child's participation in the foregoing, the undersigned acknowledge and agree to the following:

I am aware of the existence of the risk on my physical appearance to the venue and my participation to the activity of the Organization that may cause injury or illness such as, but not limited to Influenza, MRSA, or COVID-19 that may lead to paralysis or death.

I have not experienced symptoms that of fever, fatigue, difficulty in breathing, or dry cough or exhibiting any other symptoms relating to COVID-19 or any communicable disease within the last 14 days.

I have not, nor any member(s) of my household, traveled by sea or by air, internationally within the past 30 days.

I did not, nor any member of my household, visit any any area within the United States that was reported to be highly affected by COVID-19, in the last 30 days .

I have not been, nor any member(s) of my household, diagnosed to be infected of COVID-19 virus within the last 30 days.

This field should be left blank

EARTH 2 TABLE

Reading & Math After School Program

Love Our Nation Parent Consent

Home Address

Pickup Authorization