Sign Up & Waiver - Sunday Lunch Bunch

Participation agreement

Sign up & sign the waiver.

One form per teen. Fill this out before June 14 and you're all set for the summer.

About your teen

Teen's full name

Date of birth

Parent / guardian

Your name

Relationship

Mobile phone

Email address Please enter a valid email address, like name@example.com.

Emergency contacts

Contact #1 name

Contact #1 phone

Contact #2 name

Contact #2 phone

Medical information

Known allergies (food, medication, environmental)

Current medications

Does your teen carry medication during activities?

Medical conditions Deb should be aware of

Physician name & phone (for emergencies)

Parent walk sign-up

When signing up your child, I am asking for you to pick a single volunteer date that you, or another adult, will accompany Deb and the children on the walk. Deb will confirm your Sunday if we have multiple sign-ups for the same date.

Preferred walk date

Consent

I give permission for my teen to participate in the Sunday Lunch Bunch walking club.

I understand the activity involves walking 1.5 to 2 miles each way on public sidewalks in downtown Birmingham, MI, depending on the restaurant selected, in summer weather conditions.

I authorize Deb to seek emergency medical care for my teen if I cannot be reached in a timely manner.

I have reviewed the phone policy and expectations with my teen prior to participation.

I understand that if my teen needs to leave early, I will be called for immediate pickup. Any disputes will be handled collaboratively among teens and parents together.

I have provided accurate and complete medical information on this form.

Photo release

Anything else?

Anything Deb should know about your teen

Parent / guardian signature (type full name)

This form is for the private use of the Sunday Lunch Bunch group. This is a good-faith consent form and has not been reviewed by legal counsel. Families with legal questions are encouraged to consult an attorney.