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Community Education Youth Program

Community Education Youth Program
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Student name
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Student Email
required
Student Grade
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Register for the following classes
Class Name
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Address
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City
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State
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Zip Code
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Parent/Guardian Name
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Parent/Guardian Email
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Parent/Guardian Phone Number
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Additional Parent/Guardian Name
Additional Parent/Guardian Email
Additional Parent/Guardian Phone number
Today's Date
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Emergency Contact Name
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Emergency Contact Phone
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Form Consent
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I certify that the participant’s present level of physical condition is consistent with demands of active participation in this program. I agree to forever release, discharge, and covenant not to sue the Laurel Public Schools/Laurel Community Education for liability from any and all lost or damage, whether or not caused by negligence, either active or passive, by or on the behalf of the Laurel Schools/ Community Education. I will indemnify and hold the Laurel Public Schools/Laurel Community Education harmless from any and all claims made by others. I assume all the risks and hazards incidental to the conduct Laurel Public Schools/Community Education programs and I do further release, absolve, indemnify, and hold harmless the Laurel Public School/Laurel Community Education the organizers, sponsors, supervisors, volunteers, and officials of any or all of the supervisors appointed by them. I also acknowledge that participants may be photographed, videoed and recorded providing opportunity for Laurel Public Schools/Laurel Community Education promotions.
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Parent/Guardian Signature
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