NCompass Live - March 18, 2020 http://nlc.nebraska.gov/ncompasslive/

1. Cedar Rapids Public Library Release Form
Release of Liability
I am signing this Release of Liability form on behalf of my minor child who is participating in Library activities. I release the
Library and the City of Cedar Rapids, including its directors, volunteers, employees and agents, from any claim that I, or my
child, may have against them as a result of physical injury or illness incurred during participation in Library activities. In
consideration of your accepting my child for participation in this Library program, I hereby, for myself, my heirs, executor
and administrators, waive and release any and all rights and claims for damages that I may have against the Library and its
agents, employees, representatives, successors and assigns for any and all injuries suffered by myself or my child that arise
out of this program sponsored by the Library.
Transportation
Library staff and volunteers cannot provide rides to or from the Library, though children will have access to telephones to
arrange for rides. I understand that I am responsible for making transportation arrangements for my child. I release all
Library staff and volunteers from responsibility related to transporting my child to and from the Library. Should I be late in
picking up my child, I understand that my child may be left in the custody of the Cedar Rapids Police Department.
Conduct Agreement
I understand that the Library cannot assume responsibility for my child’s behavior. I further understand that my child’s
behavior must be appropriate for the Library at all times, and if it is not, that I may be asked to remove my child from the
Library. I agree to collect my child from the Library immediately if his/her behavior is deemed inappropriate enough to
require dismissal.
Photo Release (Optional)
I give my permission to the Library to use photographs of my child/children participating in this program. I understand
photos may be used in newspaper/newsletter articles, on the Library website, and/or other promotional materials for the
Library.
⃣ I give my permission ⃣ I do NOT give my permission
Child(ren)’s Name(s):
Parent/Guardian Signature: Date:
Parent/Guardian Printed Name: Relationship:
Emergency Contact 1: Phone: Relationship:
Emergency Contact 2: Phone: Relationship:
Allergies:
Medical Concerns:
Notes/Special Instructions: