Please complete the following information.
YOUR PERSONAL INFORMATION WILL NOT BE SHARED WITH ANY OTHER PARTY.

✱ Indicates REQUIRED field.

Registration Form

Please complete the following information.
YOUR PERSONAL INFORMATION WILL NOT BE SHARED WITH ANY OTHER PARTY.

✱ Indicates REQUIRED field.

Registration Form

1. THE UNDERSIGNED HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE THE SCV SENIOR CENTER, ITS EMPLOYEES, OFFICERS AND AGENTS (hereinafter referred to as “Releasees”) from all liability to the undersigned, his or her personal representatives, assigns, heirs, and next of kin for any loss, damage, or claim therefore on account of injury to the person or property of the undersigned, whether caused by any negligent act or omission, including gross negligence and/or willful disregard, of the Releasees or otherwise while the undersigned is participating in the any activity or using any of the facility in connection with such activity.

2. THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND HOLD HARMLESS the Releasees from all liability, claims, demands, causes of action, charges, expenses, and attorney fees (including attorney fees to establish the Releasees’ right to indemnify or incurred on appeal) resulting from involvement in this activity whether caused by any negligent act or omission of the release or otherwise.

3. THE UNDERSIGNED HEREBY ASSUMES AND ACCEPTS FULL RESPONSIBILITY FOR ANY AND ALL LOSS, BODILY INJURY, DEATH OR PROPERTY DAMAGE while upon the property or participating in the activity or using any of the facility and equipment whether caused by any negligent act or omission of Releasees or otherwise. The undersigned expressly agrees that the foregoing release and waiver, indemnify agreement and assumption of risk are intended to be as broad and inclusive as permitted by California law and that if any portion thereof be held invalid, notwithstanding, the balance shall continue in full legal force and effect.

By my signature below, I signify that I have read, understand, and voluntarily agree to be bound by each of the terms stated above.