I agree to the Fayetteville Athletic Club's Waiver release statement. By signing this form, I understand that I am releasing all claims for injury, I or my child may sustain through any of our programs. I agree to assume full risk and to waive, relinquish, and release all claims I and/or the participant may have against, indemnify, hold harmless and defend the Fayetteville Athletic Club. This release includes FAC officers, agents, servants, and employees from such claims resulting from injury, damages, or loss sustained while participating in the FAC program or event. I understand that I am responsible for all personal insurance and understand that I must cover any medical costs incurred for my family participating in this FAC program. I also understand that every precaution is taken to protect the safety of each participant.

I, (mother/father/guardian), do hereby give my consent to the Director of the Child Care facility, or his/her representative, for said child to receive medical or surgical aid as may be deemed necessary and expedient by a duly licensed or recognized physician or surgeon in case of emergency when parent/guardian can not be reached. Consent is also given for the Director or his/her duly appointed representative to transport said child for emergency medical treatment, if the parents cannot be reached. Please sign below.

The payment for the event must be paid by October 1st in order to register your child(ren) for the FAC Kids Night Out Event. The balance will be billed the Friday prior to the event. This balance must be paid by a credit card or bank account on file with FAC. Payments must be received for your camper to attend the Kids Night Out Event. Non-payment by the required due dates will result in relinquishing the camper's space in the event. FAC Junior Membership or enrollment in the FAC After School Program is required for each child to receive the Member discount for the Kids Night Out event. Changes or cancellation requests must be received a minimum of 5 days prior to the event and must be made in writing to the Director. FAC member discounts will be voided, and additional charges will occur if the FAC Junior membership is canceled at any time during the program duration. A $25 returned payment fee will be applied to any returned payments. Fayetteville Athletic Club accepts, Visa, Master Card, Discover, American Express, bank drafts and checks. I agree to abide by the Billing policy that has been presented.