Permission to participate in a program(s) sponsored by the Santa Cruz Parks & Recreation Department is given for myself and/or my child(ren). In consideration of participation in such program(s), I, on behalf of myself and/or my child(ren), hereby agree to release, hold harmless, indemnify and defend the City of Santa Cruz, its agents, employees, and volunteers from any and all claims or liability (including attorneys' fees and defense costs) for bodily injury or property damage arising from me or my child(ren)'s negligence or willful misconduct relating to me or my child(ren)'s participation in the above program(s).
I, on behalf of myself and/or my child(ren), understand and acknowledge that I have read the Concussion Information Sheet(PDF, 105KB) and agree to the protocols and that I have spoken with or will speak to my child(ren) about the information presented in the Concussion Information Sheet(PDF, 105KB).
Assumption of Risk/Promise Not to Sue: Participant acknowledges and understands that in participating in a Program, Participant voluntarily agrees to accept and assume any and all risks to Participant's health and safety, known or unknown, including the risk of injury, property damage, or death. Participant is voluntarily participating in the Program and accepts the potential dangers and hazards, however caused, involved in any way related to participating in the Program, which may include, but are not limited to: dangers or risks that may arise due to exposure to infectious diseases and viruses (such as the Coronavirus, COVID-19), exposure to sick or ill individuals, risk of property damage, or risk of any other type of injury (physical or mental), including death.
By voluntarily accepting all risks, known or unknown, to the fullest extent permitted by law, Participant agrees not to assert any claim, institute any suit or other legal process against the City, its officers, officials, employees, agents or volunteers for injury, death, or damage resulting from or in any way related to participation in any Program, even if the City, its officers, officials, employees, agents or volunteers (through negligence or carelessness) might otherwise be liable to Participant (or Participant's heirs or legal assigns) for damages.
Indemnification, Waiver and Release: To the fullest extent permitted by law, Participant hereby agrees to defend, release, discharge, hold harmless and indemnify the City of Santa Cruz, and its officers, officials, employees, agents and volunteers from and against all liability, actions, claims, or demands (including attorney fees and costs) for injury, death or damage arising from or in any way related to the Program even though such liability, actions, claims, or demands may arise out of the negligence or carelessness on the part of the City.
Medical Release/HIPPA Waiver: Should Participant require any medical treatment, medical services, or first-aid treatment while participating in the Program, Participant authorizes the City, its officers, officials, employees, agents and volunteers to seek and/or provide whatever medical care is recommended by a physician or other authorized medical provider, including but not limited to: the administration of any medication or first-aid treatment.
To the extent applicable, Participant authorizes any health care provider to release to City, its officers, officials, employees, agents and volunteers, any Participant's medical information which is governed under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 42 USC §1320d and 45 CFR pts 160, 164, and California law.
Participant agrees to defend, release, discharge, hold harmless, and indemnify the City of Santa Cruz, and its officers, officials, employees, agents and volunteers from any and all liability, actions, claims, or demands (including attorney fees and costs) which arise as a result of any medical or first-aid treatment.
City's Right to Cancel Program or Terminate Participation: Participant understands and acknowledges the Santa Cruz Parks & Recreation Department, on behalf of the City of Santa Cruz, has the sole discretion and reserves the right to:
- Deny or terminate enrollment by any Participant in a Program in the interest of public health and/or safety, or for any failure to comply with Program policies or rules;
- Cancel a Program due to a cancellation by the Program instructor or staff, in the interest of public health and/or safety, or due to unforeseen circumstances, natural disaster, or other peril, existing or anticipated, or other cause which is beyond the reasonable control of the City of Santa Cruz.
Photos/Videos: Participant hereby gives the City of Santa Cruz Parks and Recreation Department, on behalf of the City, the right to use photographs taken of me and/or my minor child(ren)/guardian(s) while participating in a Program for reproduction in any medium for any purposes including, advertising, trade, display, exhibition, or editorial use.
Consent to Electronic Signature: The undersigned acknowledges that an electronic or other copy of a party's signature shall be accepted and valid as an original.
THE UNDERSIGNED HEREBY CERTIFIES THAT I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS.
I FURTHER CERTIFY MY UNDERSTANDING THAT THIS AGREEMENT CONSTITUTES A RELEASE OF ALL CLAIMS AGAINST THE CITY OF SANTA CRUZ AND AGAINST ALL OTHERS MENTIONED IN THE AGREEMENT.
I FURTHER UNDERSTAND AND CERTIFY THAT BY EXECUTION OF THIS AGREEMENT I AM VOLUNTARILY ASSUMING ALL RISK INHERENT IN PARTICIPATION IN ANY PROGRAM BY PARTICIPANT (MYSELF, CHILD(REN) AND OR GUARDIAN(S).
I ACKNOWLEDGE THAT I AM VOLUNTARILY SIGNING MY NAME TO THIS AGREEMENT AND BY DOING SO AM ACCEPTING ITS TERMS AS BINDING UPON MYSELF, MY CHILD(REN)/GUARDIAN(S), HEIRS, AGENTS, LEGAL REPRESENTATIVES, ORGANIZATION, AND ASSIGNS.