Parental consent form

KAÏ PAPAÏ – Parental consent for children under 18

I, the undersigned,

Mr./Ms. : ……………………………………………………………………………………

Address : …………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………………………………………

Telephone: ………………………………… Cell phone: …………………………………

Hereby authorize my son/daughter : …………………………………………………………………..
to stay at Kaï Papaï from……………………….. to………………………

My child has allergies : yes no

If yes, specify : ……………………………………………………………………………

Since my son/daughter is under 18 year old, I hereby totally release and hold harmless Kaï Papaï’s management and staff with respect to any and all incidents, accidents and assaults that my child might suffer from during his/her stay, on the premises of Kaï Papaï as well as outside. I hereby certify that I am covered by a civil liability insurance which would cover any damage caused by my son/daughter on Kaï Papaï’s premises.

Name of insurance : ……………………………………………………………………………

Name of agent : ……………………………………………………

Telephone : ……………………………………

Address : …………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………..

Contract Number : …………………………………………

* Any damages which are caused by a child under 18 and which is not covered by the insurance shall be compensated by the parents of the child.

I hereby acknowledge that drinking alcoholic beverages and using other toxic substances is forbidden on the premises of Kaï Papaï. Should my child’s behavior justify such decision, I authorize Kaï Papaï’s management to shorten his/her stay and to call me at any time of night or day.

Made this: …………………………………. At:………………………………

Signature :