Consent to ‘Hold Harmless’

Name of parent/legal guardian *

First Name

Last Name

Name of child/ren *

First Name

Last Name

Name of staff member *

First Name

Last Name

Date babsitting period begins *

MM

DD

YYYY

Date babysitting period ends *

MM

DD

YYYY

I certify I am the parent/legal guardian of the child/ren listed above, and agree to hold Teachable Moments Preschool, LLC harmless for any harm that my child may experience while under the care of the above-mentioned staff-member. I am aware of the program’s No Babysitting Services policy, and chose to take exception to that policy. I hold Teachable Moments Preschool, LLC harmless for any harm that may befall my child when above-mentioned staff-member babysits for my child during the above-listed date-range. *

Yes