Summer Program Signup Form

Participation Permission / Medical Authorization (2025–2026)

I, the parent or legal guardian of the participant, hereby give permission for my child to participate in all Isla Vista Recreation and Park District (“IVRPD”) special events, youth programs, exploration club, sports, contests, and field trips, including swimming, from June 1, 2025 through June 30, 2026.

For field trips, I give permission for my child to walk or ride in a bus or van with IVRPD staff or volunteers with a valid California driver’s license.

In the event of an emergency, I authorize IVRPD to make arrangements for medical or hospital care, including transportation. A licensed physician or surgeon may undertake necessary treatment. This authorization is effective through June 30, 2026.

The undersigned agrees to bear all costs incurred as a result of the foregoing.

Emergency Contact Information

Agreement, Waiver, and Release

In consideration of participation in the above activities, I waive and release IVRPD from liability for injury, illness, death, or property damage, even if caused by negligence. I agree this waiver binds my heirs and assigns.

I understand the risks, including illness and communicable diseases, and agree to participate voluntarily.

Photographic Release: I grant IVRPD permission to use photos of the participant for promotional purposes.

Parental Consent: If the participant is under 18, I certify I am the parent/legal guardian and execute this waiver on their behalf. I affirm the child is physically able to participate.

I have carefully read this agreement and sign of my free will.

Optional Demographic Questionnaire

(Your answers help us improve our services and apply for funding. This section is voluntary.)