Senior Participant Authorization Waiver
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ALL INFORMATION MUST BE SUBMITTED NO LATER THAN SEPTEMBER 13, 2025

The undersigned certifies that he/she/they is physically able to participate in the South Suburban Cultural Enrichment Organization program, and that he/she/they will abide by the rules and instructions of the Organization.

 

List any known allergies/medical conditions: 

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The undersigned consents to hereby release and forever hold harmless South Suburban Cultural Enrichment Organization, its officers and members, from any and all responsibility or liability for any injuries or damages that may be incurred by the undersigned as a result of his/her/their participation in the South Suburban Cultural Enrichment Organization program.

The undersigned has read the above terms and conditions and agrees to be bound by them.

Signature of Participant: 

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Date *
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Parent or Guardian must sign if under 18 years of age
Signature of Parent/Guardian
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Date *
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A copy of your responses will be emailed to the address you provided.
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