WAIVER, RELEASE, HOLD HARMLESS AND AGREEMENT NOT TO SUE I, the undersigned, fully understand that my and/or my child(ren)'s participation in the activity(ies), hereinafter referred to as “EVENT/CLASS” exposes me and/or my child(ren) to the risk of personal injury, death, communicable diseases, illnesses, viruses, or property damage. I hereby acknowledge my and/or my child(ren)'s voluntary participation in EVENT/CLASS and agree to assume any such risks. I hereby release, discharge and agree not to sue the City of Lakewood, hereinafter referred to as “CITY”, its in connection with, my and/or my child(ren)'s voluntary participation in EVENT/CLASS from whatever cause, in EVENT/CLASS. The parties to this agreement understand that this document is not intended to release any party from any act or omission of gross negligence, as the term is used in applicable case law and/or statutory provision. In consideration for being permitted to participate in EVENT/CLASS, I hereby agree, for myself, my heirs, administrators, executors and assigns, that I shall indemnify and hold harmless all claims, demands, actions or suits arising out of or in connection with my and/or my child(ren)'s voluntary participation in EVENT/CLASS. Step 3 Participant Information Please list separately each participant and the activity information requested. 1. 2. 3. 4. Activity # Last Name First Name Activity Name Sex M/F Birth Date mm/dd/yy Fee Total non-resident fees Total of activity fees Transaction Fee Return to: City of Lakewood, P.O. Box 158, Lakewood, CA 90714 • 562 866-9771, ext. 2408 • lakewoodcity.org/recreation Print Name Method of Payment Check Money Order Cash Non-residents add the following fees for each class enrollment, if class fee is: $0-$10 no additional fee $11-$29 add additional $5 non-resident fee $30-$59 add additional $10 non-resident fee $60 and over add additional $15 non-resident fee Start Date Date Signature Required LIFE Form (Lakewood Individual & Family Enrollment) Form Steps 1 and 3. ❑ Check this box if you have a change of address, phone number or name. Be sure to also complete Step 2 with your up-to-date information. Step 1 First, give us your email address. Email: Step 2 Next, decide who the Main Contact is for your family. This is normally the person who is re- sponsible for signing up family members and paying for activities. (Note: Any refund processed for this account will be payable to the Main Contact.) City Zip Code Birth Date (mm/dd/yy) Main Contact Last Name First Name MI Cell Phone ( ) Street Address Apt. No. Home Phone ( ) the Recreation and Community Services Department at (562) 866-9771 ext. 2408 at least 48 hours in advance. Total Paid $2.16 I understand and agree that EVENT/CLASS may be recorded for viewing and/or listening by others during EVENT/CLASS and at a future date. I consent to CITY’s use of audio and video recordings and photographs of me and/or my child(ren) during EVENT/CLASS and that CITY may use audio and video segments or photographs of me and/or my child(ren) for any purpose, including but not limited to news, advertising and promotional purposes, without compensation to me and/or my child(ren). I hereby release and hold harmless CITY from any claims relating to the use of my and/or my child(ren)’s likeness and image. I HAVE CAREFULLY READ THIS RELEASE, HOLD HARMLESS AND AGREEMENT NOT TO SUE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT IT IS A FULL RELEASE OF ALL LIABILITY AND SIGN IT ON MY OWN FREE WILL.