Participant's Name *

First Name

Last Name

Parent/Guardian's name *

First Name

Last Name

Phone *

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Authorization and Agreement *

By checking the box below you agree to the following terms. RELEASE OF LIABILITY, INDEMNITY, AND ASSUMPTION OF THE RISK, I understand that the activity (ies) for which I am registering, including, but not limited to, any class, program or event “Activity (ies)” provided in connection with the City of Pacifica can be dangerous and involves the risk of injury, property damage or death. Despite the risk involved and in consideration of the right to participate, I voluntarily agree to expressly assume any and all risk of injury, property damage, or death which might be associated with participation in the Activity(ies), and use of any facilities belonging to the City of Pacifica. I agree, on behalf of myself and my heirs, successors or assigns, to hold harmless, indemnify and defend the City of Pacifica, its officers, employees, and agents (“City”) against any and all liability, claims, losses, damages, lawsuits or expenses, including reasonable attorneys’ fees, arising in connection with my participation in Activity(ies). I agree with the use of my name and/or photo for City publicity. I agree in the case of emergency City may administer CPR or arrange for medical transport. I agree the City is not responsible for lost or stolen items. I agree the City may deny me permission to participate in Activity(ies). PARENTAL/LEGAL GUARDIAN CONSENT: I give consent for my son/daughter to participate in the Activity(ies), and I execute the above Release on his/her behalf. I have read and understood the registration form; liability release and parental consent form, and agree to all their terms and conditions.

Yes, I agree.