Adaptive Soccer- Volunteer Registration

Volunteer's First and Last Name:

Volunteer's Email

Is volunteer under 18 years of age?

Yes

No

Parent/Guardian Name (IF UNDER 18)

Parent/Guardian Phone Number (IF UNDER 18)

Parent/Guardian Email (IF UNDER 18)

What dates will the volunteer participate in Adaptive Sports? Select as many as apply.

March 7

March 14

March 21

March 28

Check all that apply

Emergency Contact Information

Contact's name

Contact's Phone Number

Contact's Relationship to Volunteer

Release

Publicity Release

The Children's Center for Communication/Beverly School for the Deaf (CCCBSD) takes pride the achievements and activities of its students, families, and community members. As part of standard practice, media are used on a regular basis. These may include photos and/or videos shared as hard copy or electronically. CCCBSD will never post names within media, including social media or websites. CCCBSD does not take responsibility for images taken of your child by individuals not affiliated with CCCBSD. Further, I release CCCBSD, its Board of Trustees, employees, and other representatives from any known liabilities, known or unknown, arising out of the use of these materials. I understand and accept the publicity policy.

Liability Release

I give myself or my child permission to take part in the basketball program at CCCBSD. I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for disability, personal injury, or property damage for THE FOLLOWING ENTITIES OR PERSONS: The Children’s Center for Communication/ Beverly School for the Deaf and /or their directors, officers, employees, volunteers, representatives, and agents, and the activity holders, sponsors, and volunteers; INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this activity, whether caused by the negligence of release or otherwise. I acknowledge that The Children’s Center for Communication/ Beverly School for the Deaf and their directors, officers, volunteers, representatives, and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf. I hereby consent to medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity. If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and effect. I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL. THIS WAIVER WILL BE EFFECTIVE FROM THE SIGNED DATE BELOW AND MOVING FORWARD.

Electronic Signature

Signature (Parent/Guardian Signature IF UNDER 18)

Clear

Date

Adaptive Soccer- Volunteer Registration

Emergency Contact Information

Release

Electronic Signature

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