Liabilities Waiver

Xilin Academy Day Care Center

1163 E. Ogden Ave., Suite 300-301

Naperville, Illinois 60563

Phone: (630)355-4322 Fax: (630)355-4326 http//:www.xilin.org

Dear Parents.

Some of the activities and games we do here at Xilin can sometimes cause accident if the children don’t follow the rules during the activities. The school is not liable if something like that happen to your child.

Please sign if you agree with this letter. If your child does not follow the rules, he/she will be taken out of the room on that period.

Pency Haiyan Peng

Director

Xilin After School Program

Linda B.Yang

Director

Xilin Association

Please sign if you agree: Please sign if you don’t agree:

____________________________ __________________________

Parent Signature Date Parent Signature Date