Jefferson Success Academy Registration
Jefferson Success Academy is a program of Edgewater Collective and is not a Jeffco Public Schools sponsored program
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Student name *
Current grade (2020-2021) *
Home address *
City *
ZIP code *
School student attends *
Emergency contact number *
Relation to participant *
By my signing as participant, and on my behalf and on behalf of such minor participant and our respective heirs, assigns, successors-in-interest, executors and administrators, I voluntarily and knowingly waive, release, indemnify and hold harmless Edgewater Collective, its officers, employees, representatives, agents and assigns from any and all claims, injuries, damages, or losses, of whatever kind, nature or amount, suffered by me, to my property, or by such minor participants at any activity sponsored, in whole or in part, by Edgewater Collective to which this participant’s registration relates. I recognize that activities and services I take advantage of may result in injury, death, or damage to myself, my property, or to others, including but not limited to injuries caused by negligence and/or the actions or omission of Edgewater Collective or of third party (for example and not by way of limitation: falls, contact with other participants, injures relating to equipment or the condition of the facilities), all such risks being known and appreciated by me. I understand I am waiving any right to bring or have brought on my behalf any such claims or lawsuits against Edgewater Collective by signing this form. Participants involved in Edgewater Collective programs may be photographed and such photographs may be used to publicize Edgewater Collective activities. *
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