Take A Child to Work Day and Beyond

Waiver/Release Form

Child's Name

Age (4-18)

Parent/Guardian's Name

Work #

Department

Site (Select One)

West Palm Beach, FL

Plantation, FL

Atlanta, GA

Please indicate if the child has a medical condition

I would like a child, aged 4-18 years, to participate in Take A Child to Work Day and Beyond on Thursday, April, 24, 2025. In consideration for the child’s participation, I hereby waive, release and discharge from any and all liability for the personal injury, disability or death to the child, E.C. Fennell, Inc. its directors, officers, employees, representatives and agents, on behalf of the child and myself. I also agree to defend, indemnify and hold harmless the entities mentioned in this paragraph from any liabilities or claims made by other individuals or entities, including any loss, injury or death. This Waiver/Release and discharge, covers my personal rights and my rights as Parent and/or Guardian. I agree that while the child is at work with me, they will be with me and under my control at all times, and that I will be solely responsible for the child and their actions during the entire time that they are with me. Pizza will be provided to your child from 11:30am - 1:00pm at the Corporate location in West Palm Beach, FL.

Your supervisor must approve whether it is appropriate to bring a child to work to job shadow you.

Parent/Guardian Signature

Signature field is empty.

Date picker

Please return this waiver form to your supervisor. A completed copy of this form MUST be on file with Human Resources by 5:00pm, Friday, April 11, 2025, in order to participate.

If you have any questions or concerns, please contact Human Resources.