1st Racer Name *

First Name

Last Name

2nd Racer Name (If applicable)

First Name

Last Name

3rd Racer Name (If applicable)

First Name

Last Name

Parent Name *

First Name

Last Name

Phone

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Release

In conjunction with the NORTHERN CALIFORNIA CONFERENCE OF SEVENTH-DAY ADVENTISTS (“NCC”) and its affiliated organization, the PUC Elementary School (hereinafter the “School”) offers to its students, their parents and/or guardians, and guests an opportunity to participate in a Soapbox derby on or about October 1, 2017. While we shall strive to make this activity as safe as possible, it will still have its own inherent dangers and risks of injury or even death that cannot be completely eliminated even when well planned and supervised. These risks include that of collision with persons or objects, falls, overturning, etc. When a participant agrees to engage in activities sponsored by this School, it is the responsibility of the participant and, if the participant is under 18, his or her parent or guardian, to know their own physical limitations, learn safe techniques and to learn the proper use and limitations of each piece of equipment, if any, used in such activities. A participant should only agree to participate in an activity after taking the time to become familiar with it and its associated risks. If you have any questions about a particular activity, its physical demands, the use of associated equipment or the inherent risks associated with that activity, PLEASE contact an instructor or supervisor before agreeing to participate. I am aware that participation in the activities offered by the NORTHERN CALIFORNIA CONFERENCE OF SEVENTH-DAY ADVENTISTS, its affiliated organizations and/or the School, has inherent risks of injury and even death. Participation in these activities is voluntary and I consent to participation with the knowledge of the risks involved. In consideration of said participation, I, individually and/or on behalf of my child, agree to assume the risks of participation, and to release and discharge the NORTHERN CALIFORNIA CONFERENCE OF SEVENTH-DAY ADVENTISTS, it s affiliated organizations and/or the School, and their employees, officers, directors, members, or agents from any and all claims, demands, actions, judgments, and executions for personal injuries or injuries to property caused by, or the result of participation in an activity offered by NORTHERN CALIFORNIA CONFERENCE OF SEVENTH-DAY ADVENTISTS, its affiliated organization, and or the School, unless such injury is the result of the intentional wrongful act or gross negligence of the NORTHERN CALIFORNIA CONFERENCE OF SEVENTH-DAY ADVENTISTS, its affiliated organizations and/or the School, or their employees, officers, directors, members, or agents. By signing clicking "agree," I acknowledge that I have CAREFULLY read, understand and agree to be bound to above.

I Agree

I Do Not Agree

Media Release

I agree  that event photos and videos may be used in publications such as the school yearbook, website, class projects, or promotional materials.

I Agree

I Do Not Agree