Liability Waiver for Group activities
This must be signed and turned in with your application
I do hereby certify that I and my family are covered by our own medical insurance policy. I
understand and agree that neither GLOW Johnstown Homeschool Group, nor the facilities
in which group activities are held, shall be liable for personal injuries incurred by me or my
children while participating in a GLOW Johnstown Homeschool Group event or activity. I
also agree not to hold any staff, instructors, coaches, field trip coordinators, or any other
person(s) liable for any personal injuries incurred by me or my children while participating
in GLOW Johnstown Homeschool Group events and activities.
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Medical Insurance Carrier Policy Number
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Print Father’s Name Print Mother’s Name
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Father’s Signature Date Mother’s Signature Date
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For Office Use Only - Don't fill out!
School Year: Date Received:
Type of Membership: Full Year / Half Year (Jan to June)
Paid: Check Cash M.O. Amount: ______________ Ck # ________________
Email Added: _____ Membership Email sent: _____ Facebook Email sent: _____
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