Waiver, Release and assumption of risk in consideration of the applicant's participation in the above activity. I waive and release all claims for damages for death, personal injury or property damage that may occur as a result of engaging in that activity. This discharges in advance the city of Santa Monica, its employees and other agents from liability even though that liability may arise out of their negligence. I know that this activity involves a risk of accidents and i willingly assume the risk. This waiver, release and assumption of risk are binding on my heirs and assigns. I give permission for any medical care that the leaders of the above deem necessary. I also agree to accept full responsibility financial and otherwise, for the conduct of my child. i understand that this is no refund should my child be dismissed from class for improper conduct.
I hereby consent to the photographing,recording or reproduction in any other manner(including use of videotapes and audiotapes) of the likeness, voice and/or activities of my child and further authorize the city of Santa Monica, its agents or assigns, to make unlimited use of such reproductions, including, but not limited to broadcasting to the public of the reproductions over radio and televiosion stations. I understand that i will not receive any monetory compensation, now or in the future, for participating. i do hereby release and hold harmless the city of Santa Monica, its officers and employees, from any claims. My signature below indicates that i have read and fully agree with all registration policies stated herein : |
| Parent Signature : |
____________________________________________ |
Date : |
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| (Please Print Clearly) Camp session # :
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| Street Address : City : State : Zip : |
| Home Phone # : Work Phone # : Cell Phone # : |
| Email : |
| Emergency Contact Name : Emergency Phone # : |
| Physician : Physician Phone # : |
| * Refund Policy : Due to large volume of enrollments, we do not grant refunds, transfers or credits |
For disability related accomodotions, please call the Community Classes Office at least 7 days prior to the class
At (310)458-2239 or TTY (310-576-4754) |