Parent(s) Name: Email Address: Child's Name: Street Address: City: Subdivision: Postal/Zip Code: Home Phone: Work Phone: Cell Phone: Medical Conditions: Known Allergies: Booster Seat Needed: yes no Age of the Child in Booster Seat: Pick-up location: Drop-off location: Time: Referred by: Additional Comments: Consent to Emergency First Aid & Transportation: I hereby give permission that my child (listed above) may be given emergency treatment by a staff member at Bizzy Kidz Kab Company, LLC. I also give permission for my child to be transported by car, ambulance, or Aid car to an emergency center for treatment. I agree that Bizzy Kidz Kab Company, LLC and its employees are not liable for medical. I, also agree to save and hold harmless and indemnify each and all parties herein referred to above as releasees from all liability, loss, cost, claim or damage whatsoever, including death or damage to property, which may be imposed upon said releasees because of any defect in or lack of such capacity to so act or caused or alleged to be caused in whole or in part by the negligence of the releasees. Consent to Medical Care and Treatment: In the event that I cannot be contacted immediately, medical of surgical treatment can be administered to my child in the case of an accident or emergency, as prescribed by a treating physician, and hold Bizzy Kidz Kab Company, LLC and its employees harmless and indemnify each and all parties herein referred to above as releasees from all financial liability. I agree to the terms and conditions I agree to follow the guidelines with Bizzy Kidz Kab Co., LLC as outlined in the policies and payment guidelines. I understand that my child WILL NOT be transported without first signing a General Terms and Conditions Agreement.
