Parent/Caregiver Name *

First Name

Last Name

Parent/Caregiver DOB *

MM

DD

YYYY

Waiver *

ROOTED IN PLAY WAIVER OF LIABILITY / ASSUMPTION OF RISK I, for myself, my child/children or ward/wards sign this Waiver and Assumption of Risk in consideration of the opportunity to participate in any activities by ROOTED IN PLAY. I, for myself, my child/children or ward/wards acknowledge and understand that there are dangers and risks associated with the activities by ROOTED IN PLAY and agree to assume all risk of personal injury, including the potential for paralysis and death. I, for myself, my child/children or ward/wards, and on behalf of my or their heirs, assigns, personal representatives and next of kin, HEREBY HOLD HARMLESS ROOTED IN PLAY, its owners, members, officers, employees, equipment manufacturers and sponsoring agencies from all liability for any such personal injury, disability, death or loss or damage to person or property to the fullest extent of the law. By checking "yes," you acknowledge that you have read, understood, and agree to our liability waiver.

Yes

No

Photo Release *

I, for myself, my child/children or ward/wards grant ROOTED IN PLAY permission to use myself or my children in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration. If you answer "No", please promptly inform a staff member to receive a special sticker for your child, ensuring that we respect your preference and refrain from publicly sharing their photograph. By checking "yes," you acknowledge that you have read, understood, and agree to our photo release policy.

Yes

No