Email Address (required)
Name of participant (First) (required)
Last Name (required)
Birthdate (if under 18)
Age
Grade
Sex
Address (Street, City, Zip) (required)
Telephone (required)
Parent's name (if participant is a minor)
Parent's Telephone
Emergency Contact (First and last name) (required)
Emergency Contact Telephone (required)
Additional Comments:
Any and all recreation activities involve the risk of injury. You, as the participant, must be aware of the particular risks involved in the activity you have signed up for. For example, a softball player runs the risk of breaking an arm while diving for a ball, or being struck by a thrown ball; a calligraphy student may fall and break a bone while walking out of class or to their chair; an excursion participant may trip and fall from the bus or the bus itself may be involved in an accident. In any event, participants must understand that all activities have the potential for an injury and Paradise Recreation and Park District is not liable. Participants must understand and agree that they take part in the activity at their own risk. In consideration for being permitted by the District to participate in the above-referenced activity, I hereby waive, release, and discharge any and all claims for damages for personal injury, death, or property damage which I may have, or which may hereafter accrue to me, as a result of participation in said activity. This release is intended to discharge in advance the District (including its officers, employees, volunteers, and agents) from any and all liability arising out of or connected in any way with my participation in said activity, even though that liability may arise out of active or passive negligence or carelessness on the part of the persons or entities mentioned above. It is further agreed that this waiver, release and assumption of risk is to be binding on my heirs, administrators, executors, and assigns and that I shall indemnify and hold the District (including its officers, employees, volunteers, and agents) free and harmless from any loss, liability, damage, cost, or expense which may arise out of or connected in any way with my participation in said activity. Additionally, I fully understand that my participation in the above-referenced activity exposes me to the risk of personal injury, death, communicable diseases, illnesses, viruses, and/or property damage. I hereby acknowledge that I am voluntarily participating in this activity and agree to assume any such risks. VIRTUAL CLASS RELEASE: I hereby warrant and agree, that the conditions of my environment are safe, free from obstructions, and are suitable for participation in the above-referenced activity. I further understand and agree that any material downloaded, viewed or otherwise obtained through my participation in said activity is done at my own risk and the District is not responsible for any loss, alteration, corruption or other damage to my personal property, including computers, networks and other property used as part of my participation. PHOTOGRAPHIC RELEASE: I understand that photographs may be taken during this activity and hereby grant the District permission to use any such photo(s) for advertising or in promotional materials.
I hereby consent that my son/daughter,______________________________, participate as a volunteer in the above-referenced activity, and I hereby execute the above Agreement, Waiver, and Release on his/her behalf. I state that said minor is physically able to participate in said activity. I hereby agree to indemnify and hold the District (including its officers, employees, volunteers, and agents) free and harmless from any loss, liability, damage, cost, or expense which may arise out of or connected in any way with said minor’s participation in said activity.
Date (required)
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