Youth Registration Form

will your child be transported or walking?

Liability Release Form

I (parent or guardian’s name), grant permission for my child, to participate in Plainfield Now’s youth summit that requires transportation to College Achieve Central Charter School in North Plainfield, NJ on Saturday November 16, 2019. I agree on behalf of myself, my heirs, assigns, executors and personal representatives, to hold harmless Plainfield Now, its officers, directors, agents, employees or representatives associated with the event, from any and all liability claims, loss or damage arising from or in connection with my child’s participation in this event. In case of an emergency, I hereby give permission to transport my child to a hospital for emergency or surgical treatment. If needed for health reasons, I give permission for my child to be evaluated, diagnosed, treated and/or given medication in accordance with standard medical practice by licensed medical personnel. I relieve Plainfield Now of all responsibility and consequences that may arise as a result of this treatment. I agree to accept any and all financial responsibility as a result of scheduling medical treatment. I wish to be advised as soon as possible prior to any further treatment by the hospital or doctor.
If I am unable to be reached at the time of the emergency, please contact:
My signature on this form gives your organization my permission to use my child’s likeness publicly to promote Plainfield Now. I understand that the images and/or video may be used in print publications, online publications, presentations, websites, and social media. Students are required to participate in the full day of Summit events. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.
Allowing the permission


If you do not have a PayPal account, you can still use your Credit Card to pay via PayPal.

For more information, contact
Tel. (908) 543-4673 | E:

© Copyright 2018 All rights reserved. Legal Disclaimer | Privacy Policy