Special Events - Boys and Girls Club of the Pikes Peak Region

FREE STEAM DAY

Friday, June 24th

Join the Boys & Girls Club of the Pikes Peak Region & Collins Aerospace volunteers for a FREE Community STEAM DAY to engage in fun & awesome STEAM activities!

See details below and sign up ASAP!

SCIENCE. TECHNOLOGY. ENGINEERING. ART. MATHEMATICS

Where: E.A. Tutt Boys & Girls Club

1455 S. Chelton Rd. C/S, CO 80910

When: Friday, June 24th from 12pm-4pm

Who: 5-18 year old's

Deadline to RSVP: Friday, June 10th (to RSVP complete the form & waiver below)

Parents of non-Club members MUST sign off on the special event waiver and consent form below.

Parents of non-Club members MUST accompany youth 5-12 years old.

Flyer

Youth Name

Youth Age

Youth Gender

Youth Ethnicity

Military Branch:

Military Status:

Youth Health Concerns and/or Allergies

Parent/Guardian Name

Parent/Guardian Phone Number

Additional Emergency Contact Name (someone other than the parent/guardian already listed)

Additional Emergency Contact Phone Number

SPECIAL EVENT WAIVER & CONSENT FORM

In consideration of my child being permitted to participate in the Event described above, I voluntarily agree for myself and my child/children that:

1. I fully realize the dangers of participating in the Event and will instruct my child that such participation could result in injury or even death to him/her (“Risks”). I realize these Risks may be caused by my child’s actions or inaction, these

actions or inaction of others participating in the Event, or the negligence of the Club, and there may also be other Risks which are not known to or anticipated by me. If my child or I believe anything is unsafe, I will instruct my Child

not to participate in the Event and will so notify the program.

2. I consent to my child’s participation in the Event and assume and agree not to sue the Boys & Girls Club with respect to any Risks known and unknown, and assume all responsibility for any losses, costs, and damages which may

arise from any injury or death to or of my Child.

3. I release the Boys & Girls Club from all liability to me, my child, and my child’s personal representative, assigns and heirs for all claims and damages which my child or I may have in connection with the Event.

4. If, despite this release, my child, I, or anyone on my child’s behalf make a claim against the club, I agree to identify and hold harmless the Boys & Girls Club from any attorney fees, damages, or cost it may incur due to such a claim.

By typing in my name and checking the box below, I agree to the terms of the special event waiver and consent.

Parent/Guardian Name

Date

Submit Waiver & RSVP