2026-2027 CIP Member Registration Form
This form collects member information to register for the Corvallis Indoor Park. 
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Please select membership type *
PRIMARY/DESIGNATED CAREGIVER First Name (this is the person who will be the primary point of contact with CIP) *
PRIMARY/DESIGNATED CAREGIVER Last Name (this is the person who will be the primary point of contact with CIP) *
Email address for communication with CIP *
Phone number for communication with CIP ########## (no parentheses, spaces or hyphens please)
*No contact information or personal information will ever be shared with any 3rd parties. Phone numbers may be used to send CIP-related notifications for events, reminders, or other relevant communication.*
 *
SMS Notification Opt-Out for Corvallis Indoor Park
(OPTIONAL - additional caregiver) First Name
(OPTIONAL - additional caregiver) Last Name
(OPTIONAL) Secondary email address for communication with CIP (ideal if you'd like multiple caregivers to receive email communications!)
(OPTIONAL) Secondary phone number for communication with CIP (ideal if you'd like multiple caregivers to receive texts or phone calls)
Address Line 1 (Street number, Street name, Apt #) *
Address Line 2 (City only) *
Zip Code *
Emergency contact name (first and last) *
Emergency contact phone number (###)###-#### *
Member Waiver of Liability for Corvallis Indoor Park

The facilities of the Corvallis Indoor Park (CIP) are for the purpose of providing an indoor play area for children under the supervision of their caregivers. The organization is a non-profit parent co-operative using space at First Presbyterian Church in Corvallis.

In consideration of my child(ren) attending the Corvallis Indoor Park, I FREELY AND VOLUNTARILY AGREE TO ASSUME ALL RISKS incident to or arising from my child(ren)’s participation and use. The Waiver of Liability shall cover any accidents and/or injury to myself and/or my child(ren) arising out of neglect or intention, which may occur during my presence and/or the presence of my child(ren) at the Corvallis Indoor Park.

**ILLNESS CLAUSE: I agree to self-monitor for signs and symptoms of illness and contact corvallisindoorpark@gmail.com if anyone in our household tests positive for contagious diseases within 14 days of participating in activities at Corvallis Indoor Park  I also agree to review the CIP sickness guide requiring that my child(ren) be free of fever (without medication) and without any vomiting or diarrhea for at least 24 hours in order to play at CIP.**

I understand the general supervision of my child(ren) on the premises is MY RESPONSIBILITY. I agree to abide by all CIP rules and job expectations as outlined in the Site Guide.

I further agree to HOLD HARMLESS AND RELEASE Corvallis Indoor Park, Inc., First Presbyterian Church, and any participating parents from any and all claims, demands, or causes of actions for damages or injury, known or unknown, that I or anyone else may have against them incident to or arising from my child(ren)’s participation at the Corvallis Indoor Park.

By electronically signing this Member Waiver of Liability for the Corvallis Indoor Park, I certify that I am the parent or guardian of the minor(s) names below and have the legal authority to execute this Waiver and Release. I have read the above statement and agree to its terms and conditions.

Disclaimer: Corvallis Indoor Park (CIP) may photograph or record video of membership events. Photos and/or videos taken at CIP of CIP members and affiliates, including parents, guardians, designated caregivers, and children under 18, may be used in paper and digital publications, news releases, social media promotions, and other communications related to the mission of Corvallis Indoor Park. CIP reserves the right to use photos taken at membership events for the aforementioned purposes after obtaining verbal consent of the parent, guardian, or designated caregiver of children under 18. CIP will remove subjects from photos or remove photos if requested.

Name(s) of my child(ren) who will attend the Corvallis Indoor Park: *
Member Waiver of Liability for Corvallis Indoor Park *
Required
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