*1.Participant Name:(Required.)

*2.Participant Grade:(Required.)

*3.Participant Allergies/ Medical Conditions:(Required.)

*4.Participant Dietary Restrictions:(Required.)

*5.Parent/Guardian Name:(Required.)

*6.Parent/Guardian Phone Number:(Required.)

*7.Emergency Contact Name:(Required.)

*8.Emergency Contact Phone Number:(Required.)

*9.Waiver of Liability, Release & Indemnity Agreement Notice:
This is a legally binding agreement. I understand that by signing this Waiver of Liability, I release and hold harmless the Boys & Girls Clubs of Tustin, its Board of Directors, officers, advisors, employees, agents, instructors, volunteers, and all other persons or entities acting for them from any and all claims, demands, suits, costs and charges, in connection with or arising out of the Boys & Girls Clubs of Tustin’s program service, including but not limited to, personal injury, bodily harm, injury or property damage occurring while the below child is in the care of the Boys & Girls Clubs of Tustin.(Required.)

I understand

*10.Consent to Emergency Treatment:
I hereby grant permission to the Boys & Girls Clubs of Tustin and its staff full authority to take whatever actions they deem necessary regarding my child’s health and safety in the event I cannot be reached or in the situation where time is of the essence; and fully release the Boys & Girls Clubs of Tustin and its staff from liability in connection with those decisions. I grant permission for emergency treatment by a registered nurse, hospital or emergency health care facility staff if needed. Any such action will be taken in the best interest of my child and will be report to me as soon as possible. I knowingly and voluntarily waive any and all claims, actions, or causes of action against the Boys & Girls Clubs of Tustin and agree to hold the Boys & Girls Clubs of Tustin, its Board of Directors, agents, affiliates, and employees harmless for any injury or damage that I may suffer as a result of my activities at the Boys & Girls Clubs of Tustin.(Required.)

I understand

*11.Photo Release:
I hereby grant the Boys & Girls Clubs of Tustin permission to use my likeness, and that of my child, in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration. I understand and agree that all photos will become the property of the Boys & Girls Clubs of Tustin and will not be returned. I hereby irrevocably authorize the Boys & Girls Clubs of Tustin to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photo. I hereby hold harmless, release, and forever discharge the Boys & Girls Clubs of Tustin from all claims, demands, and causes of action, which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have because of this authorization.(Required.)

I understand

*12.Acknowledgement:
I hereby warrant and represent that I am the parent or legal guardian of the participant and I am 18 years old or older; I have carefully read this consent and agree to its terms and conditions, that before signing this agreement I had the chance to ask questions; and I am aware that by signing this consent, I assume all risks and waive and release certain substantial rights that I and the participant may have or possess against the Boys & Girls Clubs of Tustin. This permission and release is binding on me and my executor, administrators, and heirs. To the extent permitted by applicable law, I hereby irrevocably and unconditionally waive trial by jury in any legal action or proceeding related to this agreement. I expressly agree that this consent is intended to be as broad and inclusive a release of liability as permitted by applicable law and that if any provision thereof is held invalid, it is agreed that the remaining provisions shall, notwithstanding, continue in full legal force and effect.(Required.)

I understand

*13.Pick Up Policy:
I acknowledge that pick up is between 2:30pm-2:45pm.(Required.)

I understand