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Sign Up for E-Life

E-Life Sign-up and Waiver

Participant name(Required)
Parent Name (if participant is a minor)
Email(Required)
(only used for emergency contact purposes only)
Program you're signing up for (check all that apply)(Required)
Has your child participated in a group activity program before?(Required)
Does your child have a “special need” or a medical diagnosis (e.g., allergies, asthma, hemophilia, heart condition, history of respiratory illness, or other significant medical condition, etc.) related to their ability to participate in any E-Life program that the program officials should be aware of?*(Required)
Please select any of the following conditions that may apply to the participant (you or your child):(Required)
Please indicate the percentage of one-on-one instruction you feel your child will need to successfully participate in a group program:*(Required)
Consent(Required)
ASSUMPTION OF RISK: I, the undersigned parent or legal guardian of the participant, a minor, for myself and on behalf of the participant, our heirs, assigns and next of kin, acknowledge that participation in the E-Life Program activities or events involves risk of physical injury or sickness from infectious disease and possible death. For myself, and on behalf of the participant, our heirs, assigns and next of kin, we willingly and voluntarily accept and assume all such risk. WAIVER, RELEASE AND INDEMNIFICATION: In consideration of E-Life Program permitting the voluntary participation of the participant in its programs, I, the undersigned parent or legal guardian of the participant, a minor, for myself and on behalf of the participant, our heirs, assigns and next of kin, hereby waive all claims and release, discharge, agree to hold harmless and indemnify the E-Life Program, its board of directors, officers, employees, volunteers, officials, sponsors and other representatives from any and all actions, claims, costs, expenses and demands of every kind and description including, but not limited to, personal injury, sickness, property damage and death, based on negligence, contract claim or other legal theory, arising out of, during or in any way related to the minor participating in E-Life Program activities or events. PERSONAL INFORMATION - CONSENT, WAIVER AND RELEASE: I, the undersigned parent or legal guardian of the participant, a minor, for myself and on behalf of the participant, our heirs, assigns and next of kin, hereby consent and give permission to the E-Life Program to take and compile program related photographs, film, video and/or audio clips of the participant and to use them, along with my name and/or the name of the participant, as well as program related personal information about myself and/or the participant, in any printed material, film, video, audio or other medium, including CD, Internet or other electronic media, describing, advertising or promoting the E-Life Program. In consenting to such uses, we hereby waive the right to inspect and approve the images and information used, as well as all rights to compensation. We further release the E-Life Program from any and all claims regarding use of the images or information, including, but not limited to, claims related to defamation, invasion of privacy, or infringement of moral rights, rights of publicity or copyright. I HAVE READ THE ABOVE ASSUMPTION OF RISK, WAIVER, RELEASE AND INDEMNIFICATION AND PERSONAL INFORMATION -CONSENT, WAIVER AND RELEASE, AND I FULLY UNDERSTAND THE TERMS OF EACH. I FURTHER UNDERSTAND THAT THE PARTICIPANT AND I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY MY SIGNING THIS FORM AND AGREEING TO THESE TERMS. I AM AWARE THAT THIS FORM IS A LEGALLY BINDING AND ENFORCEABLE AGREEMENT, AND I SIGN THIS FORM AND AGREE TO THESE TERMS FREELY AND VOLUNTARILY, WITHOUT INDUCEMENT FOR MYSELF, AND ON BEHALF OF THE PARTICIPANT.
Sign me up for newsletter(Required)
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