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2. Student Name (First name, Last name)*
4. School*
5. Grade*
   -- Select One --678
7. Student's sweatshirt size

   Please specify whether the size is youth or adult. 

9. Address*
11. City*
12. Zip Code*
14. Parent/Guardian Name*
15. Parent/Guardian Email Address*
17. Parent/Guardian Phone Number*
19. Parent/Guardian Address (If different than student)
21. Emergency Contact Name*
22. Emergency Contact Email Address*
24. Emergency Contact Phone Number*
26. Comments

    Include any info that you want us to know about your student (dietary restrictions, etc.).

28. Release of Liability & Waiver Agreement*

    (a) Release: I agree to participate, or allow my child to participate, in the program sponsored by the City of Woodbury. I understand that participation in the program is completely voluntary and that the program is being offered as an optional activity for the benefit of the participants and that there is no requirement to participate in the program. In consideration of my or my child’s participation, I agree that all activities undertaken by me or my child as part of the program are undertaken by me or my child, at my or his/her own risk, and that the City of Woodbury and its employees, agents or volunteers, shall not be liable for any claim, demand, injury, damage, action or causes of action whatsoever to myself, or my child, or my property, or my child’s property, due to the passive or active negligence of the City of Woodbury, or its agents, employees, or volunteers, arising out of or, connected with my or my child’s: (i) participation in the program; (ii) the use or operation of equipment in this program; or (iii) the actions of any other participants in the program. My child and I agree not to sue and expressly forever release and discharge the City of Woodbury and its officers, agents, employees, and volunteers from all claims, demands, injuries, damages, actions or causes of action whatsoever.

    (b) I agree that the above release includes an assumption of all risks related to COVID-19 (or “Coronavirus”). I agree that the City of Woodbury and its employees, agents or volunteers, shall not be liable for any claim, demand, injury, damage, action or causes of action whatsoever arising out of my or my child’s illness, injury, or death due to contraction of or exposure to COVID-19. I agree that I, or my child, will follow all City, state, and federal guidelines, policies, and other applicable authority and laws related to COVID-19. 

    (c) Media Permission: The City of Woodbury reserves the right, and may give permission to the media, to photograph classes, programs and participants at any of our facilities and properties or any sponsored activity. These photos are used for promotional purposes and may be used on all forms of social media and other communications the City utilizes. If you see a City of Woodbury staff member or designate taking photos, and you wish not to be photographed, please inform us immediately. I understand that my agreement to the foregoing terms is required before my or my child’s participation in this program is allowed. 

    1. I have read this Agreement carefully and know and understand its contents, and agree.
30. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
32. Electronic Signature
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field