Teen Center Guest Pass 21'

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Teen Center Guest Pass 21' - 22'

First Name / Nombre *

Last Name / Apellido *

Gender / Sexo *

Male / Hombre

Female / Mujer

Non-Binary /

Not Listed Above / No enlistado

Prefer Not to Say / Prefiero no decirlo

Other:

Grade / Grado *

8th

9th

10th

11th

12th

Home Address / Direccion de casa *

Email ( Cannot be your student email ) *

Phone Number / Número de teléfono *

Parent's / Guardian's Name / Nombre del padre/Guardián *

Parent's / Guardian's Phone Number / Teléfono del padre/Guardián *

Emergency Contact Name / Nombre de contacto de emergencia *

Emergency Contact Phone Number / Teléfono de contacto de emergencia *

Relationship to Emergency Contact / Relación con contacto de emergencia *

Allergies or Medical Conditions? ( If None Leave This Space Blank ) / ¿Alergias o condiciones médicas?

I understand that some Carver Center activities have inherent risks and I hereby assume all risks and hazards incident to participation in all Carver activities. I further waive, release, absolve, indemnify and agree to hold harmless Carver, the organizers, volunteers, supervisors, officers, directors, participants, coaches, referees, as well as, persons providing services through the Teen Center.

Student Signature / Firma digital del estudiante *

Today's Date / Fecha *

YYYY

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