Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

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Birthday Date *

MM

DD

YYYY

Check if applicable *

I'm authorized to leave the premises for lunch

I'm authorized to leave with the Museum staff for field trips or assist with Outreach Programs

Parent or Guardian's Name *

Adults- Enter your information

First Name

Last Name

Parent's Phone *

(###)

###

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Waiver *

I release the Children's Museum of the Treasure Coast, its representatives, members, officers, employees, volunteers, contractors, and agents from any and all liability for any injury or claim arising from my child's participation. This waiver includes any claims based on negligence or other actions by the aforementioned parties.