Participant Information

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CHOOSE A PROGRAM
CHOOSE A PROGRAM

PARTICIPANT INFORMATION
PARTICIPANT INFORMATION

* PARENT/GUARDIAN INFORMATION: AUTHORIZED TO PICK UP AND OBTAIN/CHANGE REGISTRATION INFORMATION 

Father/Guardian
Father/Guardian
 
Mother/Guardian
Mother/Guardian
 

* EMERGENCY CONTACT AND PERSONS AUTHORIZED TO PICK UP MY CHILD: (Must be at least 16 years of age)
* EMERGENCY CONTACT AND PERSONS AUTHORIZED TO PICK UP MY CHILD: (Must be at least 16 years of age)
*We reserve the right to request proof at any time.

HEALTH INFORMATION


The information provided here will be held in the strictest confidence. It will be kept on file in our binder or carried by the program coordinator on field trips. 


Allergies

HEALTH INFORMATION The information provided here will be held in the strictest confidence. It will be kept on file in our binder or carried by the program coordinator on field trips. Allergies

If your child has any special need that requires specific accommodations so your child can fully enjoy the program, please contact Ivan Carrillo (661) 290-2296, or icarrillo@santa-clarita.com. To ensure appropriate accommodations, please request inclusion services a minimum of two weeks in advance.


Medication
Will your child need to take medication while at the program? 
Will your child need to take medication while at the program?

Any medication taken by your child must be brought in its original prescription container and a separate form must be completed. 

*Staff cannot administer medication. Your child needs to be able to take the medication on their own.


PERMISSION TO PARTICIPATE


I have the authority and voluntarily agree for my child to participate in City operated activities or programs, or any extension thereof. I hereby waive, release, and hold harmless from any liability or claims for damages for personal injury, including  death, as well as from claims or property damage which may arise in connection with such activities or programs, against the Supervisors, City of Santa Clarita, and its elected and appointed officials, agents, and employees.  As a parent/guardian, I hereby consent to treatment of my minor child for any and all medical procedures deemed necessary as a result of accident or injury.  I further agree to pay any and all costs incurred as a result of said treatment.  I hereby give permission to the City of Santa Clarita to use my child(ren)’s photographs as they see fit for promotional purposes.  I understand the photographs belong to the City and I will not receive payment of any kind.

 

 

PERMISSION TO PARTICIPATE I have the authority and voluntarily agree for my child to participate in City operated activities or programs, or any extension thereof. I hereby waive, release, and hold harmless from any liability or claims for damages for personal injury, including death, as well as from claims or property damage which may arise in connection with such activities or programs, against the Supervisors, City of Santa Clarita, and its elected and appointed officials, agents, and employees. As a parent/guardian, I hereby consent to treatment of my minor child for any and all medical procedures deemed necessary as a result of accident or injury. I further agree to pay any and all costs incurred as a result of said treatment. I hereby give permission to the City of Santa Clarita to use my child(ren)’s photographs as they see fit for promotional purposes. I understand the photographs belong to the City and I will not receive payment of any kind.
Parent/Guardian 
Parent/Guardian
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