Activity Waiver and Registration Form

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Course/Activity Title *

Name of Participant *

D.O.B.

+-

Fee *

Name of School *

Shirt Size *

Activity, program or area you will be participating in: *

For swimming lessons please answer the following:

Age:

Height:

Attending Summer School?

Yes

No

Last Level in Swimming:

All must sign the following:

PLEASE READ AND SIGN THE WAIVER AND INDEMNITY AGREEMENT (“AGREEMENT”) BELOW

In consideration of being permitted to participate in the City of Hawaiian Gardens recreational program (“program”) and to use City facilities and/or those facilities not owned by but made available through the City in conjunction with the program (collectively referred to herein as “City Facilities”), the undersigned, on behalf of himself or herself, and on behalf of any minors in the legal custody of the undersigned, and on behalf of the undersigned’s personal representatives, heirs, assigns and next of kin, agrees to the following:

1. The undersigned herby releases , waives, discharges, covenants not to sue, agrees to indemnity and save harmless the City of Hawaiian Gardens, its officers, agents, employees, volunteers and representatives (collectively “City”), for and against any loss, damage, or cost, including, without limitation, any claims or demands on account of personal injury, property damage or death, including attorney’s fees, which may occur as a result of the named participant(s)’ (“Participant”) presence during or participating in the program and/or use of any City Facilities and/or City equipment while participating in the program, even though that injury or damage may arise out of negligence of the City or out of a dangerous or defective condition of property or equipment of the City or City Facilities. This release and indemnity shall further extend to owner of any facility on which Program activities occur.

2. The undersigned hereby assumes full responsibility for and risk of bodily injury, death or property damage while the undersigned and/or the Participant is present during or participating in the program. The undersigned expressly acknowledges and understands that accidents and injuries can occur while present during or participating in the Program, including serious and permanent personal injuries or death, and that the undersigned hereby expressly assumes all of the risks due the actions, omissions, or negligence of the City or due to a dangerous or defective condition of public property, otherwise , whether or not particular risk is known or unknown.

3. The undersigned expressly agrees and hereby given permission for, and expressly assumes the risk of, any emergency medical treatment that may be rendered, at the sole discretion of the City, to the undersigned and/or the Participant if the undersigned and/or Participant is injured while present at or participating in the program. The undersigned hereby agrees to expressly release and indemnify the City against any liability for providing, or failing to provide, any emergency medical treatment as set forth herein. The undersigned further agrees to pay all costs incurred because of said treatment.

4. The undersigned expressly agrees that foregoing Agreement is intended to be as broad and inclusive as permitted by the law of the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

5. This Agreement is intended by the parties to be a waiver of California Civil Code Section 1542 which reads as followed: “A general release does not extend to claims that the creditor or releasing party does not know or suspect to exist in his or her favor at the time of executing the release and that, if known by him or her, would have materially affected his or her settlement with the debtor or released party.”

6. The undersigned and/or the Participant hereby grants full permission to the City and any of its employees or agents to record any or all of their participation in the program for photos, TV, radio, recordings, videotapes, and other media, and to use them in any manner for publicity, promotions, advertising, or commercial purposes, without any compensation of any kind due. The abovementioned recordings are the property of the City.

7. ASSUMPTION OF THE RISK AND WAIVER OF LIABILITY RELATING TO COVID-19. The City has created protocols and put in place preventative measures to reduce the spread of COVID-19; however, the City cannot guarantee that the undersigned and/or the Participant will not become infected with COVID-19 when using the City Facilities or attending any program, and participation may increase the risk of contracting COVID-19. By signing below, the undersigned acknowledges the contagious nature of COVID-19 and voluntarily assumes the risk that the undersigned and/or the Participant may be exposed to, or infected by COVID-19 by attending the program or using the City Facilities, and that such exposure or infection may result in personal injury, illness, permanent disability, and death. The undersigned understands that the risk of becoming exposed to or infected by COVID-19 at the program or by using the City Facilities may result from the actions, omissions, or negligence of others, including, but not limited to, City employees, volunteers, and program participants and their families. The undersigned voluntarily agrees to assume all of the foregoing risks and accept sole responsibility for any injury to the undersigned and/or the Participant including, but not limited to, personal injury, disability, and death, illness, damage, loss, claim, liability, or expense, of any kind in connection with attendance at the program or use of the City Facilities. The undersigned hereby releases, covenants not to sue, discharges, agrees to indemnify and holds harmless the City, its employees, officials, volunteers, agents, and representatives, of and from all claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating to participation in the program or use of the City Facilities, including but not limited to as it relates to exposure, contraction, or infection of COVID-19 and any injury, illness, permanent disability, and death that may result therefrom.

8. THE UNDERSIGNED HAS CAREFULLY AND FULLY REVIEWED THE AGREEMENT AND UNDERSTANDS IT. THE UNDERSIGNED UNDERSTANDS THE RISKS INVOLVED IN THE PARTICIPATION OF THE PROGRAM OR USE OF THE CITY FACILITIES. THE UNDERSIGNED FURTHER UNDERSTANDS THAT THEY ARE GIVING UP LEGAL RIGHTS BY SIGNING THIS AGREEMENT, AND GIVE UP THE RIGHT TO SUE THE CITY. THE UNDERSIGNED SIGNS THIS RELEASE FREELY AND VOLUNTARILY AND WITHOUT INDUCEMENT.

The undersigned further agrees that no representations, statement, or inducements of any kind, apart from the foregoing written Agreement, have been made. *

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