adult programming education form

Adult Programming Education Form

Name*
First Last
Pronouns:
Phone
Email*
Are you Hispanic or Latinix?*
- Yes
- No
Race: How would you describe your race? (check all that apply)*
Where did you hear about the program?
Do have any accessibilty needs?*
- Yes
- No
If you answered Yes, please describe so we can best accommodate you. If No, please skip
Release of Liability*
I agree to the release of liability form
I do hereby agree and consent to participation in YWCA Olympia programs and do assume all risks and hazards which are part of the conduct of the associated activities. I hereby release, absolve, indemnify, and hold harmless YWCA Olympia, their officers, directors, employees, contracted employees, independent contractors, instructors, agents, organizers, and volunteers of any and all liability for damage, injury, or expense of any kind arising out of or connected with my participation in YWCA Programs.

I understand that in case of a medical emergency, my own personal medical plan will be used. As a condition of participation in YWCA Programming, I acknowledge that I have read this consent form, and knowingly, assume all of the risks associated with participating in any way in YWCA Programming.

I hereby release, to the fullest extent permitted by law, the YWCA Olympia and their affiliates, from any and all actions, claims, demands, or liabilities that I, my assignees, heirs, distributes, guardians, and legal representatives now have or may hereafter have for injury or damage resulting from my participation in these activities irrespective of whether the same is based on breach of warranty, negligence, strict liability or any other theory or recovery.
Release of Liability Statement*
- I have READ and AGREE to the Release of Liability
By checking this box, you agree to YWCA's Release of Liability