Release of Liability

* indicates a required answer.

I do hereby release Pennyroyal Area Christian Home Educators of Kentucky (PACHEK), its officers, volunteers and/or member parents, and host church/facility from any legal or financial liability for injury to my child which may occur while my child is participating in activities organized or sponsored by PACHEK.  I authorize my child to participate in activities organized or sponsored by PACHEK with the understanding that the supervision being provided for such activities is being provided by lay teachers and volunteers, not certified child care providers.  I understand that I am responsible for my child’s safety and well being, and I do not expect or require PACHEK members to assume responsibility for my child. 
 
I promise to instruct my child in appropriate behavior for age integrated play and to take my child from a situation if I become aware of inappropriate behavior or if I am asked to do so by a supervising adult. 
 
If a situation arises concerning my child, in which I feel a wrong has been committed, I will follow the steps outlined in Matthew Chapter 18 with the goal of restoring relationships.
 
Matthew 18:15-17 (NKJV) “Moreover if your brother sins against you, go and tell him his fault between you and him alone. If he hears you, you have gained your brother.   But if he will not hear you, take with you one or two more, that by ‘by the mouth of two or three witnesses every word may be established’ and if he refuses to hear them, tell it to the church.  But if he refuses even to
hear the church, let him be to you like a heathen and a tax collector”.
 
I certify, before this witness, that I have read and do agree to this release of my own free will, without coercion, and do sign my  name below as a testimony of my agreement. I understand that this signed form shall be kept on file by PACHEK.  I understand that I may revoke my agreement at any time and elect to keep my children away from PACHEK activities.
1. *

By typing my name below I am signing this Release of Liability form.

2. *

Date

Class Behavior Agreement
The following behavior agreement is valid for all child care situations where PACHEK volunteers and/or paid child care workers are responsible for the care and safety of my children.  This is to include co-op classes and nursery.
 
I understand that students are expected to maintain Christian standards of kindness, honesty, and respect for authority at all times, participate in activities with a positive attitude, follow instructions, treat other students with thoughtfulness, and to encourage each other.
 
The students will be taught to respect the host facility by keeping the area clean and not to deface the property with either complacency or any type of vandal action.  I agree to take personal, financial responsibility for any damages caused by a member of my family.
 
Class teachers/helpers will generally be responsible for ‘first line’ discipline (i.e. ‘please sit down’, ‘Johnny, please don’t hit’, etc.)
After this attempt to set the behavior right, the teacher/helper makes the decision to go to the parent.  It is the parent’s responsibility to respond if their child has become a disruption beyond the ‘first line’ of discipline.  I understand that other parents
will be, at times, correcting my child.  I understand that if I have consistently had to take my child out of classes due to behavior, then the leadership may make the decision to keep my child out of non-parent activities.
 
If I volunteer as a class teacher/helper, I will follow the guidelines of lovingly providing the ‘first line’ of discipline for all children.
I will use my good judgment to decide when it is necessary to involve the parent.  If I am needed to correct another family’s child, I will do so in love and with patience. I agree to follow the PACHEK policies for discipline and conflict resolution.
3. *

By typing my name below I am signing this Class Behavior Agreement.

4. *

Date

Please annotate all appropriate information for PACHEK records.

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Child's Name                                         Birthday                                       Allergy/Medical Info

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Child's Name                                         Birthday                                       Allergy/Medical Info

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Child's Name                                         Birthday                                       Allergy/Medical Info

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Child's Name                                         Birthday                                       Allergy/Medical Info

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Child's Name                                         Birthday                                       Allergy/Medical Info

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Child's Name                                         Birthday                                       Allergy/Medical Info

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Child's Name                                         Birthday                                       Allergy/Medical Info

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Child's Name                                         Birthday                                       Allergy/Medical Info

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Child's Name                                         Birthday                                       Allergy/Medical Info

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Child's Name                                         Birthday                                       Allergy/Medical Info

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