CCASC RSVP: 3/9 Children/Teen- Johnson Ranch Hike
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Date: 3/9/24 from 9:00-10:30am

Join us for a hike around the north loop of Johnson Ranch with a Park Ranger! Details subject to change on weather.

Name of Participant *
Participant's Age *
Participant's Email (or guardians email) *
Participant's Pronouns
Emergency Contact (Full Name) *
Emergency Contact (Phone) *
Is there anything you would like to share about participant? Likes, dislikes, level of communication, goals for event, etc.
Can we use pictures of participant on social media and/or marketing purposes? We will never use embarrassing or stigmatizing images.
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I hereby advise that the participant has the following allergies, reactions to any medications, or physical conditions, which should be made known to a treating physician. If none, please write: "none".
 *
Participant above has permission to participatein event (event name above).

I understand and acknowledge that this event could pose a risk to participant, including the risk of bodily injury and serious injuryor death.  

I (we), as parent(s) or guardian(s) of the participant (or of age participant themself), do hereby, for my child, myself, my heirs, executors and administrators, release and forever discharge Central Coast Autism Spectrum Center and all officers, directors, employees, agents and volunteers of the organization, acting officially or otherwise, from any and all claims, demands, actions or causes of action which in any way arise from the participant's participation in the above noted event. 

I hereby certify that the participant is my child or under my guardianship or I am of legal age and I do hereby certify that to the best of my knowledge and belief said minor or myself is in good health. In case of illness or accident, permission is granted for emergency treatment to be administered. It is further understood that the undersigned will assume full responsibility for any such action, including payment of costs. 

Type your name below (by typing your name, that is your e-signature and you agree to terms stated above. If you would prefer to fill out paper copy, please type 'paper' instead of your name).
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