I agree to the terms and conditions of the following disclaimer and agree by submission of this request to all terms and conditions as outlined.

I allow my son/daughter/ward to participate in Knights of Pythagoras Mentoring Network's program. I understand that my son/daughter/ward will not leave the Knights of Pythagoras Mentoring Network's program site during the program hours and that unauthorized departures from the Knights of Pythagoras Mentoring Network's meeting site, as well as any violation of KOPMN rules, may result in termination of his attendance in the program. If this occurs, I agree to pick up my son/daughter/ward immediately upon notification.

I will not hold responsible the Knights of Pythagoras Mentoring Network for liability for injury or damages arising from the result of my son's/daughter's/ward's participation in the Program, unless it is due to willful fault for gross negligence on the part of the organization. I hereby give permission for my son/daughter/ward to receive medical treatment, if necessary, while attending the program with the Knights of Pythagoras Mentoring Network.

I hereby approve of my son's/daughter's/ward's participation in this educational/mentoring program. To the best of my knowledge, there are no physical or other conditions, which will interfere wwith my child's participation.

Note: If there are conditions of which the KOPMN needs to be aware with regard to your child's/ward's participation in the program, please use the below form to elaborate.