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Carmel Clay Parks & Recreation Waiver & Release

On my behalf and on behalf of my heirs and assigns, I HEREBY RELEASE, WAIVE, DISCHARGE, COVENANT NOT TO SUE AND AGREE TO HOLD HARMLESS THE CARMEL/CLAY BOARD OF PARKS AND RECREATION, CARMEL CLAY PARKS & RECREATION, CITY OF CARMEL, CLAY TOWNSHIP, ITS AND THEIR OFFICIALS, OFFICERS, PASSHOLDERS, INDEPENDENT CONTRACTORS, EMPLOYEES AND VOLUNTEERS (the 'Releasees'), from any and all claims or liability for personal injury or property damage my child and/or I may cause or suffer directly or indirectly arising out of or relating in any respect to participation in a program, event, service or facility provided by or made available through Carmel Clay Parks & Recreation. This waiver and release of all claims, demands, actions, and liability shall include, without limitations, any injury, damage or loss to person or property which may be (a) caused by any act, or failure to act, by Releasees even if said injury, damage or loss results from the negligence of any or all of the above-identified Releasees or (b) sustained by me during and/or at the Carmel Clay Parks & Recreation program, event, service or facility in which I and/or my child participate(s).

Photo and Video Policy

Photos and video are periodically taken of participants in a class, during an event, or within Carmel Clay parks and facilities. Photos and video footage are for the use of Carmel Clay Parks & Recreation and may be used in the Department's publications, website, and social media. All photos are the property of the Carmel/Clay Board of Parks and Recreation. For more information, please contact the Marketing Director at 317.573.4020 or llabas@carmelclayparks.com. By signing this registration form, I understand and acknowledge my photo and the other participants listed may be utilized in marketing materials for the Department.

Carmel Clay Parks & Recreation reserves the right, at its sole discretion, to withhold and/or withdraw permission to photograph on its premises or to reproduce photographs of objects in its collections. Please follow our photo shoot process and submit the Photo Shoot Application available at http://carmelclayparks.com/policies/.

Statement of Accessibility

Carmel Clay Parks & Recreation believes every individual has the right to participate in activities and programs that supports their physical, mental, social and emotional wellness, and therefore contribute to enhancing their overall quality of life.  This is achieved by identifying and removing barriers to serve individual and community needs, in addition to providing accessible quality programs and services to all.  All requests for modifications must be submitted in writing through our Request for Modifications form available at http://carmelclayparks.com/monon-community-center/mcc-documents/. Please indicate on this form if any modifications are requested for successful inclusion into a program or service in accordance with the Americans with Disabilities Act (ADA).

Code of Conduct

All users of facilities are expected to exhibit appropriate behavior at all times while participating, spectating or attending any program, event, service and/or facility provided by Carmel Clay Parks & Recreation. This includes in programs, events, services or facilities that may or may not require an admission fee, spectating at athletic events, concerts or attending special events. The following guidelines are designed to provide safe and enjoyable facilities for all users. Users shall: show respect to all users and facility staff/supervisors; take direction from facility staff/supervisors; refrain from using abusive or foul language; refrain from causing bodily harm to self, other users or facility staff/supervisors; and refrain from damaging equipment, supplies and facilities. A written or verbal warning shall be given to users/spectators if the Code of Conduct rules have been violated. If there is a second occurrence, users/spectators shall be withdrawn from the facility without a refund.

I have read and fully understand the policies and the Carmel Clay Parks & Recreation Waiver and Release presented on this form. I understand my signature, or my primary guardian's signature if I am under 18, is required to use the Carmel Clay Parks & Recreation facility.

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email
Check to receive Carmel Clay Parks & Recreation news by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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