Child Registration Form

Please complete one form for all of your children

Are video cameras present in your home?*
Am I allowed to administer medication to the children?*
Disclaimer *
I/We undersigned acknowledges, understands and agrees to the following with respect to Sheri Lopez (Nanny Sheri) & other nannies subcontracted for events. 1. TO WAIVE ANY AND ALL CLAIMS that I/We have or may in the future have against Sheri Lopez (Nanny Sheri) & other nannies subcontracted for events AND TO RELEASE Sheri Lopez (Nanny Sheri) & other nannies subcontracted for events, its officers, trustees, agents, and employees, from any and all liability for any loss, damage, expense or injury, including death, DUE TO ANY CAUSE WHATSOEVER, INCLUDING NEGLIGENCE, BREACH OF CONTRACT, OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE ON THE PART OF Sheri Lopez (Nanny Sheri) & other nannies subcontracted for events; 2. TO HOLD HARMLESS AND INDEMNIFY Sheri Lopez (Nanny Sheri) & other nannies subcontracted for events from any and all liability for any property damage, loss or personal injury to any third party; 3. This Agreement shall be effective and binding upon my heirs, next of kin, executors, administrators, assigns and representatives; 4. This Agreement and any rights, duties and obligations as between the parties to this Agreement shall be governed by and interpreted solely in accordance with the laws of Arizona and no other jurisdiction; and 5. Any litigation involving the parties to this Agreement shall be brought solely within the state of Arizona and shall be within the exclusive jurisdiction of the Courts of the state of Arizona. I HAVE READ AND UNDERSTOOD THIS AGREEMENT, AND AM AWARE THAT BY SIGNING THIS AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND ASSIGNS MAY HAVE AGAINST SHERI LOPEZ (NANNY SHERI) AND OTHER NANNIES SUBCONTRACTED FOR EVENTS.
SUBMIT
Thank you! Your message was sent successfully.