Hope Horizon East Palo Alto Registration Form 2023

I understand that all releases listed below apply to all participants, parent/s & or guardians:

For your child(ren) and or parent/s/guardian to be a participant/s in our programs, we must have permission for the following:

Permission to participate in Hope Horizon East Palo Alto Programs

I give permission for my child(ren) to participate in all program activities including biblical teaching, outings, sessions, workshops, sports, performance/s, and any other functions.

Performance/Publication/Media Rights Release

• Recognizing that all items listed below are strictly for the purpose of promoting Hope Horizon East Palo Alto Programs:

• I give Hope Horizon East Palo Alto the right to publish and copyright any and all creative works generated by my child(ren) in the following media: social media, book, newspaper, magazine, radio, television, videocassette, etc.

• I further permit Hope Horizon East Palo Alto to use any photographs, video images and sound, and/or audio sounds of my child(ren) for the purpose of promoting Hope Horizon East Palo Altoprograms.

• I forfeit the right to be compensated for any of the above for my child(ren), myself, or my heirs.

Release of Liability

• In consideration of being allowed to participate in Hope Horizon East Palo Alto athletic programs, related events, and activities it is agreed that:

• The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,

• I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of others, and assume full responsibility for participation; and

• I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard, I will bring such to the attention of the nearest official immediately; and,

• I, for myself and on behalf of my heirs, assigns, personal, personal representatives, and next of kin, hereby release, discharge, and hold harmless Hope Horizon East Palo Alto their officers, officials, agents, and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event, with respect to any and all injury, disability, death, or loss or damage to person or property, to the fullest extent permitted by law, whether arising from negligence or otherwise.

Medical Release/Permission for Treatment/Release to Administer Medicine

I give authorization for Hope Horizon East Palo Alto staff members to administer the medications(s) listed below and any others in writing at a future date as authorized or directed by a doctor, parent, and/or guardian. I agree to release Hope Horizon East Palo Altofrom any liability related to medications, which are permitted to be administered as noted below.

I do hereby authorize all volunteers and employees of Hope Horizon East Palo Alto as an agent(s) for the undersigned to consent to any x-ray, examination, anesthetic, medical and/or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of any physician and/or surgeon licensed under the provision of the Medicine Practice Act or the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at the office of said physician or surgeon or at said hospital.

It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required and is given to provide authority and power on the part of our aforesaid agent(s) to give specific consent for any and all such diagnosis, treatment, or hospital care which the aforementioned physician or surgeon, in the exercise of his/her best judgement, may deem advisable. I also agree to release Hope Horizon East Palo Alto, its staff and volunteers from any financial responsibility related to any and all such diagnoses, treatment or hospital care mentioned above. I, the parent/guardian of participants listed on Side 1, have read, understand and agree to all of the releases noted above.

Note: All of the above releases will remain in effect for the entire time each participant is enrolled in Hope Horizon East Palo Alto's programs or until revoked in writing to the address listed below.

By submitting this form, you verify that you are the legal parent or guardian of the registered student.

Hope Horizon East Palo Alto Registration Form 2023 - 2024

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Hope Horizon East Palo Alto Registration Form 2023 - 2024

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