Child's First Name Child's Last Name Child's Birthdate I voluntarily consent for this minor child to participate in the Play Cafe and to use O'Fallon First United Methodist Church facilities and equipment located at 504 E. Hwy 50; O'Fallon, IL 62269.* Yes I acknowledge and agree that this child and I are participating in the Play Cafe at our own risk, and I accept any and all risk of injury to either of our persons or damage to personal property. I will not hold O'Fallon First United Methodist Church or The Learning Tree responsible for any accident, injury, damage or loss.* Yes I acknowledge and agree that while participating in the Play Cafe, I shall be solely responsible for the supervision of this child. I shall be solely responsible for monitoring his/her behavior to ensure that he/she behaves in a safe and respectful manner, interacts respectfully with others in attendance, and uses toys in a safe, appropriate fashion for which they were designed. I acknowledge and understand that OFFUMC or Learning Tree staff will not be responsible for any supervision of this child.* Yes Parent/Guardian Name Parent/Guardian Phone Number Parent / Guardian Email Address