2020 Summer Online Adventure Play Registration
Thank you so much for joining us! We just need to capture a couple things to get you ready to roll.

Please email us at info@scvadventureplay.com if you have any questions at all.
Email address *
Please submit separate registration forms for EACH CHILD who is participating.
Player's Last Name *
Player's First Name *
Other Name Player prefers to go by (nick name, etc.) *
Player's Preferred Pronouns to be used in sessions *
Required
Player's Birthdate *
MM
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DD
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YYYY
Player's Current Age *
Player's Grade in School this coming Fall *
Are there any learning sensibilities regarding this player we should know about? *
Does this player need any language interpretation service? *
Primary Contact First and Last Name *
Street Address *
City *
State *
Zip Code *
Primary Contact Phone (enter as 000-000-0000 ) *
Primary Contact Phone Type *
Alt. Phone 1
Alt. Phone 2
Primary Contact Email *
Who referred you to SCV Adventure Play or how did you find out about us? *
Required
Questions for our Inclusivity Mission
The SCV Adventure Play Foundation strives to be an inclusive program for all individuals. The following questions help us understand the populations we are currently serving and to monitor the diversity of our program whether online or in-person.

Please help us serve you better by selecting the best answers to these questions.
Player's Preferred Spoken/Written Language *
Required
Which categories describe the Player? (Check all that apply) *
Required
Which Identity best describes this Player at this time? *
Required
Player's Current Orientation (if applicable) *
Required
Is this Player in a Migrant/refugee family? *
Does this Player have access to an outdoor space on a regular basis? (Yard, park, etc.) *
We are so excited to offer this program absolutely FREE!
But we want to give you the option to donate to us so that we can do more programs like this in the future! If you'd like to help sustain us providing opportunities for self-directed play, please follow these links to donate! Thanks for your consideration :)

To Donate Funds: https://scvadventureplay.square.site

To Donate Materials: https://www.scvadventureplay.org/get-involved or email us at info@scvadventureplay.com
ACKNOWLEDGEMENTS AND AGREEMENTS
I acknowledge that I am the guardian of the participant and Therefore able to register this Player. I verify that the information put forward is correct and valid for further communication.

I acknowledge that I have the technical ability to participate in the play sessions including access to the internet, zoom platform, and technical equipment which can run zoom.
RELEASE
SCV Adventure Play Release Form
Parent/Guardian or Participant 18yrs or older, hereafter known as Releasor, wishes the Participant to participate in the SCV Adventure Play Event named on this document and participate in all activities except as noted on this form.

1. In consideration for the participation in the Online Adventure activities, Releasor hereby RELEASES and covenants not-to-sue SCV Adventure Play Foundation and its affiliates for any and all present and future claims resulting from ordinary negligence on the part of SCV Adventure Play Foundation and its affiliates for property damage, personal injury, or wrongful death arising as a result of engaging in or receiving services for SCV Adventure Play Foundation and its affiliates activities or activities thereto, wherever, whenever, or however the same may occur.

2. Releasor hereby voluntarily waives any and all claims or actions resulting from ordinary negligence, both present and future, that may be made by Releasor’s family, estate, personal representative, heirs, or assigns. Further, Releasor realizes that participation in SCV Adventure Play Foundation and its affiliate’s activities involves certain risks and danger and may be a vigorous activity involving severe respiratory and cardiovascular stress.

3. Releasor accepts and understands that supervision of the participant is not the responsibility of the SCV Adventure Play Foundation and any affiliates. Thereby participant remains under the supervision of releasor and releasor waives any and all claims of responsibility of ordinary negligence or toward SCV Adventure Play Foundation and any affiliates.

4. In addition, I understand and accept the incidental risks of online play including any that may exist in the environment which participatory activities are taking place and release SCV Adventure Play Foundation and its affiliates from any legal action on this basis including any injuries which may occur due to the location of the participant, and environmental and or other spatial factors.

5. In the event of a medical emergency, the SCV Adventure Play Foundation or its representatives have my permission to take whatever measures they deem reasonable to render assistance and that I and/ or my family will be financially responsible for any expense involved.

6. I have read and understand that this WAIVER is intended to be as broad and inclusive as permitted by the laws of the State of California and agree that if any part is held invalid, the remaining parts of this WAIVER AND RELEASE will continue in full force and effect as intended. I further agree that the venue for any legal proceeding shall be in the State of California.

Photo and Creative Release
I hereby grant to the SCV Adventure Play Foundation the irrevocable and unrestricted right to use, reproduce, publish and copyright artwork and other creative productions from the event, photos and video recordings of myself and or child/ward taken in the course of the SCV Adventure Play Foundation activity; and to use such photos for any lawful purpose, in any manner or medium, and to alter the same without restriction including promotional purposes.

I Agree to these Terms *
Today's Date *
MM
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DD
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YYYY
DIGITAL SIGNATURE
By my eSignature verification below, I verify that I understand that electronic signatures are legally binding and have the same meaning as handwritten signatures. Pursuant to section 11.100 of Title 21 of the Code of Federal Regulations, this is to certify that I confirm that this electronic signature is to be the legally binding equivalent of my handwritten signature and that the data on this form is accurate to the best of my knowledge.

This Signature confirms and binds you and the player to the terms set forth in this document.
Signature *
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