After-School Sign-up

After School Registration

Participant's First Name

Participant's Last Name

Age

D.O.B

Gender

School

Emergency medical information

Parent /Guardian First Name

Parent /Guardian Last Name

Phone Number

Address

City

State

ZIP

Release Authorization

Waiver Agreement

IN CONSIDERATION of being permitted to utilize the facilities, services and programs of Community Lifestyle for any purpose, including, but not limited to observation or use of facilities or equipment, or participation in any off-site program affiliated with Community Lifestyle, the undersigned, for himself or herself and any personal representatives, heirs, and next of kin, hereby acknowledges, agrees and represents that lie or she has, or immediately upon entering or participating will, inspect and carefully consider such premises and facilities or the affiliated program. It is further warranted that such entry into Community Lifestyle for observation or use of any facilities or equipment or participation in such affiliated program constitutes an acknowledgement that such premises and all facilities and equipment thereon and such affiliated program have been inspected and carefully considered and that the undersigned finds and accepts same as being safe and reasonably suited for the purpose of such observation, use or participation. IN FURTHER CONSIDERATION OF BEING PERMITTED TO ENTER COMMUNITY LIFESTYLE FOR ANY PURPOSE INCLUDING, BUT NOT LIMITED TO OBSERVATION OR USE OF FACILITIES OR EQUIPMENT, OR PARTICIPATION IN ANY OFF-SITE PROGRAM AFFILIATED WITH COMMUNITY LIFESTYLE. THE UNDERSIGNED HEREBY AGREES TO THE FOLLOWING: THE UNDERSIGNED HEREBY RELEASES, WAIVES, DISCHARGES AND CONVENANTS NOT TO SUE Community Lifestyle, its directors, officers, employees, and volunteers (hereinafter referred to as “releasees”’) from all liability to the undersigned, his/her personal representatives, assigns, heirs, and next of kin for any loss or damage, and any claim or demands therefor on account of injury to the person or property or resulting in death of the undersigned, whether caused by the negligence of the releasees or otherwise while the undersigned is in, upon, or about the premises or any facilities or equipment therein or participating in any program affiliated with Community Lifestyle. THE UNDERSIGNED is in normal health and can participate safely in the Community Lifestyle Programs/Events. THE UNDERSIGNED authorize the Director of Community Lifestyle to act in my behalf in accordance with their best judgment in case of an emergency and to obtain necessary medical treatment for my child with the understanding that the family will be notified as soon as possible. THE UNDERSIGNED hereby forever release and discharge the Community Lifestyle and the subsidiaries, affiliates, parent companies, partners, predecessors, assigns, present and former officers, owners, shareholders, directors, agents, and employees of each and every one of the aforesaid entities against any and all causes of action, claims, suits, controversies, agreements, promises, judgments, demands or claims whatsoever, that I or my spouse, heirs, executors, administrators, successors or assigns have or hereafter, at any time, shall or may have arising out of or in connection with Participant’s participation in the Community Lifestyle Programs/Events, whether arising due to negligence or otherwise.

By accepting and typing my name I hereby authorize Community Lifestyle and give my consent to all above

Digital Signature