Sebastopol Community Cultural Center

"Enriching the Spirit of Community!"

Class Registration

Kinder Kickz Soccer
08/27/2018 - 01/14/2019

Location

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Waiver Statement:

Liability Release: In consideration of participation in this activity/activities, I agree to indemnify and hold the Sebastopol Community Cultural Center (SCCC) harmless and release SCCC and the City of Sebastopol, its officers, employees, and agents from any and all liability for any injury arising out of the activity/activities. I understand and accept that SCCC does not provide medical insurance. I have read this liability release and fully understand that I assume all risk for any injuries received by me or by any minor participant for whom I am signing this release.

Parental/Guardian Consent (if participant under 19) As the parent or legal guardian, I give consent for the minor to participate in the above activity/activities and I execute the Liability Release on his/her behalf. I also agree to be financially responsible for any damage caused by the minor during the activity/activities.

Medical Release for Minors As the parent or legal guardian, I give consent to the Sebastopol Community Cultural Center to provide all emergency dental or medical care prescribed by a duly licensed physician (M.D.), osteopath (D.O.), or dentist (D.D.S.), under whatever conditions are necessary to preserve the life, limb, or well being of the minor. Please let the front office know if this minor has any allergies.

Media Release (optional) The Sebastopol Community Cultural Center and the City of Sebastopol have my permission to make and use film, video, audio recordings, slides, and photographs of me or the minor participant. I understand that this permission includes re‐use and re‐publishing. I give my permission for this use to include marketing, promotional, and informational purposes. I release SCCC and the City of Sebastopol, its officers, employees, and agents from any and all liability for any injury arising out of this use, including any and all claims for libel and invasion of privacy.

By checking this box you agree that you have read the Liability Release, Parental/Guardian Consent (if participant under 19), Medical Release for Minors, and Media Release (optional) liability release and fully understand that you assume all risk for any injuries received by you or by any minor participant for whom you are signing this release.

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