Participant Name *Participant’s Birthday *MonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year212421232122212121202119211821172116211521142113211221112110210921082107210621052104210321022101210020992098209720962095209420932092209120902089208820872086208520842083208220812080207920782077207620752074207320722071207020692068206720662065206420632062206120602059205820572056205520542053205220512050204920482047204620452044204320422041204020392038203720362035203420332032203120302029202820272026202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924Participant’s SexMaleFemaleIdentify as LGBQ+TransgenderNonbinaryDo Not Wish To SayPrimary Contact Phone Number *Parent/Guardian Name *Secondary Contact Phone Number *Please Indicate If Participant Has Any Special Needs/Allergies/Medications Or Other Information We Should Know About (Optional)Emergency Contact Person Name *Emergency Contact Phone Number *CurrencyUSDWAIVERPlease read the following waivers and agreements carefully. They include releases of liability and waiver of legal rights, and deprive you of the ability to sue certain parties. By agreeing electronically, you acknowledge that you have both read and understood all text presented to you as part of the checkout process. PARTICIPANT WAIVER The undersigned fully understands that my child’s participation in Clicbitz and Educreate classes and events (“Activities”) exposes my child to the risk of personal injury, death, communicable diseases, illnesses, viruses (specifically including but not limited to COVID-19), or property damage. I hereby acknowledge that participation in these “Activities” is voluntary and agree to assume any such risks. I hereby release, discharge and agree not to sue the Clicbitz, Educreate, or its officers, employees or agents, for any injury, death or damage to or loss of personal property arising out of, or in connection with, my participation in the event/class from whatever cause, including the active or passive negligence of Clicbitz, Educreate, or its officers, employees or agents, or any other participants in the “Activities”. 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 that term is used in applicable case law and/or statutory provision. Further, in consideration for being permitted to participate in these “Activities”, I hereby agree, for myself, my heirs, administrators, executors and assigns, that I shall indemnify and hold harmless Clicbitz and Educreate from any and all claims, demands, actions or suits arising out of the connection with my child’s participation in these “Activities”. This document is intended to be as broad and inclusive as is permitted by the laws of the State of California; if any portion hereof is held invalid, the balance shall continue in full force and effect. I HAVE CAREFULLY READ THIS RELEASE, HOLD HARMLESS, AGREE NOT TO SUE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT IT IS A FULL RELEASE OF ALL LIABILITY AND SIGN IT OF MY OWN FREE WILL.WAIVERI assign to Clicbitz, Educreate and its officers, employees and agents, all rights to any photographs and/or video taken of my child/me and/or any organization(s) represented by me, and any printed matter in conjunction with such photographs and/or video hereinafter referred to as “Material”, for advertising, marketing and for grant-writing purposes. I hereby authorize Clicbitz and Educreate to reproduce, copy, exhibit, publish or distribute any and all such “Material”. I and/or any organization(s) represented by me understand and agree that Clicbitz and Educreate will be held free and clear of any responsibility or claim for any liability directly or indirectly associated with the use of said “Material”.CODE OF CONDUCTThe Code of Conduct has been established to help Clicbitz and Educreate carry out their missions. We ask and expect all participants to help us provide the best possible environment and experience for all to enjoy. Class and event participants, including children, must: 1. Follow all Clicbitz and Educreate rules, ordinances, policies, and staff directions. 2. Respect others. 3. Respect all equipment, facilities, and property. 4. Refrain from using threatening or foul language, and obscene gestures. 5. Refrain from causing bodily harm to yourself and others. 6. Refrain from exhibiting suggestive, provocative, offensive clothing or physical displays. 7. Be responsible for your actions. Your behavior and conduct may not interfere with others’ safety and ability to enjoy and participate in activities, programs, classes, or events. Clicbitz and Educate staff reserves the right to use professional judgment to determine if behavior and actions are in violation of this Code of Conduct. Clicbitz and Educreate welcome people of all backgrounds and abilities to enjoy our programs. We will make every reasonable effort and modification to provide access and accommodations to activities. Failure to follow this Code of Conduct may result in disciplinary action, up to and including expulsion from future programming, forfeiture of fees, and financial or other restitution for damages and inability to attend future programming. Acts conducted by a minor are the responsibility of the parent or guardian. Additional rules may apply to particular programs as deemed necessary by Clicbitz and Educreate.SubmitPlease do not fill in this field.
