Los Gatos-Saratoga | Winter-Spring 2021 | Recreation Guide

One Form Per Household Feel Free to Copy Form or Register Online at www.LGSRecreation.org To Register Online at www.LGSRecreation.org • Fax to 408-775-8366 Drop off this form through the mail slot in the front door of our main office at 123 E. Main Street, Los Gatos, CA 95030 Office Hours: Monday – Friday, 8:00AM – 5:00PM Last Name First Name Home Phone Mobile Phone Address City Zip Email Address (required) Participant First Name Participant Last Name Participant Birthdate Signature Date of wavier Indemnification: The undersigned, in consideration of participation in the programs operated by Los Gatos –Saratoga Community Education and Recreation (LGS Recreation), agrees to indemnify and hold LGS Recreation , its Board of Directors, contractors, employees and volunteers harmless and release LGS Recreation , its Board of Directors, contractors, employees and volunteers from any and all liability for any injury which may be suffered by the named individual(s) registered in any program operated by LGS Recreation, arising out of, or in any way connected with participation in such program. I have read the above application and agreement, and fully understand that I assume all risks for any injuries received. Model Release: I release the photographer and LGS Recreation from liability for any violation of any personal or proprietary right I have in connection with any reproduction of or use of photographs in which I appear. I consent to the reproduction or use of photographs, without my name (or other registered participants), taken of me while participating in LGS recreation programs. LGS Recreation and its photographer will only take photographs and videos in a public setting in which there is a reasonable expectation of privacy. I understand I will not receive any compensation for use of such pictures or video. This Waiver of Claims/Assumption of Risk/Consent applies to future participation in all programs of LGS by all signatories and minors on whose behalf it has been signed. AND/OR I have fully read this Agreement and fully understand its content. Furthermore, the significance of this release of liability and assumption of risk agreement has been EXPLAINED TO THE MINOR. I certify that I have custody or am the legal guardian of said minor and that I and/or my minor child are physically able to participate in recreation activities. In the event I or said minor requires medical treatment while under the supervision of staff and/or agents, I authorize said staff to provide and/or authorize medical treatment. I expect staff to contact me immediately in the event emergency medical treatment is required for said minor, but this contact is not necessary to administer emergency aid. I will pay for all medical treatment which I or said minor may require. Participants of virtual recreation classes acknowledge they are responsible for ensuring their environment is safe/free from obstructions and that any use of third-party applications (e.g., Zoom, Instagram, etc.) at their own security risk. Model Release: I release LGS Recreation and any photographer retained by it from liability for any violation of any personal or proprietary right I have in connection with any reproduction of or use of photographs in which I or my child appear. I consent to the reproduction or use of photographs, without my name (or those of other registered participants) taken of me or my child while participating in LGS recreation programs. I hereby grant permission to include pictures and/or video of me and/or my child while participating in LGS recreation program, for brochures or other publicity efforts. LGS Recreation and its photographer will only take photographs and videos in a public setting in which there is a reasonable expectation of privacy. I understand I will not receive any compensation for use of such pictures or video. This Waiver of Claims/Assumption of Risk/Consent applies to future participation in all programs of LGS by all signatories and children on whose behalf it has been signed. Refunds and Transfers are permitted up to 5 business days before the start of program unless otherwise stated. There is a cancellation fee of $10 for classes up to $100 and $25 for classes over $100. Transfer Fee is $10. All fees are per participant, per program. Participants Name Gender Date of Birth (Child) Program Title Start Date Start Time Program Fee Last First n M n F $ n M n F $ n M n F $ n M n F $ n M n F $ n M n F $ n M n F $ n M n F $ Payment Options: n Credit Card n Check (payable to LGS Recreation) n Cash (in person only) Credit Card Number: Total: $ Expiration Date: Name as it Appears on the Card: Authorized Signature For Registration Information, see page 1 Los Gatos-Saratoga Recreation | Winter/Spring 2021 1 WINTER/SPRING 2021 REGISTRATION