Route 87 Community Teen Center

Medical

Emergency Contacts

(If possibly please list two emergency contacts)

I have read the completed application and understand the Code of Conduct for the Route 87 Community Teen Center and request that my child be admitted into membership.

I have explained the Code of Conduct to my child and agree that Route 87 Community Teen Center will not be held responsible for any accident involving my child while on the Route 87 Community Teen Center premises or while engaged in any of its activities away from the Route 87 Community Teen Center.

I understand that by signing this form I am giving the Route 87 Community Teen Center consent to use photos or videos of my child for promotional and/or advertising purposes.

WAIVER & RELEASE

In consideration for a membership into the ROUTE 87 Community Teen Center ("ROUTE 87'') and to participate in activities conducted at, by and through the Teen Center and its staff, administrators, community partners, Gila County and the State of Arizona and any of their employees, agents, volunteers and interns, ("Releasees"):

ASSUMPTION OF RISK: I agree that I and/or my teen/ward am voluntarily participating in the activities offered by ROUTE 87, including, but not limited to, the use of equipment, facilities and the premises. I am assuming on behalf of myself and/or teen/ward, all risk of personal injury, death, or disability to myself and/or teen/ward that my result from participation, or any damage, loss or theft of any personal property which me and/or teen/ward may incur. I understand that the ROUTE 87 facility, equipment, games, events and the concentration of numerous teens in one building, present INHERENT RISKS. Further, I have explained these risks to my teen/ward. In spite of the risks, including but not limited to the inherent risks noted above, I freely want my teen/ward to be permitted in ROUTE 87 and participate in activities associated with ROUTE 87, to be allowed to use the equipment at ROUTE 87, to participate in activities outside of the facility coordinated by ROUTE 87 staff, administrators, and/or governing bodies; AND as such, I assume all the responsibility for any and all injuries or death that may result.

RELEASE OF LIABILITY: I understand that ROUTE 87 is a facility provided at no charge to teens that have graduated 8th grade, have not graduated high-school, and/or have not turned 20 years old. Therefore, I understand this WAIVER & RELEASE in no way affects, limits, or detracts from the legal protections and/or legal processes afforded to governmental entities, governmental employees, governmental volunteers; specifically, Gila County, the State of Arizona, and any and all employees, agents, volunteers of those governmental entities but is instead meant to supplement and enhance those protections to the MAXIMUM extent allowable by law. With that understanding, it is my voluntary and informed decision to fully release any future lawsuits or claims that I or my teen/ward may have against the Releasees. Therefore, I agree on behalf of myself and my teen/ward and our personal representative, successors, heirs, and assigns to hold Releasees, agents, employees, designers, licensors, and members, as well as the manufacturers and installers of the equipment comprising the facility harmless from any and all claims or causes of action arising out of me and/or my teen/ward participation with any activity occurring at or associated with ROUTE 87 and Releasees.

I expressly waive, release and forever discharge Releasees from any and all liability, claims, demands or causes of action whatsoever arising out of any damage, loss, personal injury, or death to me or my teen/ward, while participating in any of the activities at or associated with ROUTE 87. This includes, without limitation, use of any equipment, strenuous bodily movement, or actions of other members in, around, or associated with ROUTE 87. This release of liability is valid and effective whether the damage, loss, or death is a result of any act or omission on the part of any Releasees or from any other cause. This Waiver and Release of Liability includes, without limitation, injuries, or accidents, which may occur as a result of the: (a) use or misuse of the facility in any way by anyone, (b) use of any equipment that malfunctions or breaks, (c) improper maintenance of the facility, grounds, or any equipment, (d) instruction or supervision, or (e) slipping, tripping, and/or falling while in the facility or on the surrounding premises. This Waiver & Release of Liability also expressly includes a release for any and all claims arising out of or under A.R.S.§ 33-1551.

I will inspect the portions of the ROUTE 87 facility that I intend to allow my teen/ward to use. I understand that the responsibility for complying with any equipment limitations imposed by myself is between myself and my teen/ward. I understand that Releasees are in no way responsible for limiting my teen/ward's access to any of the equipment or facility.

Code of Conduct

I understand The Route 87 Community Teen Center was made possible through the generous support of Gila County and Community Partners. As such, I agree to uphold the Code of Conduct to keep the center a safe and nice place for everyone to enjoy.

• We are all created equal, regardless of race, religion, gender, or social class. Treat others as you would like to be treated -­‐ with respect.
• Come with a good attitude. This is a place to have fun, be creative, and make new friends.
• Be sensitive to the feelings of others. Offer a helping hand if you see someone who needs a friend.
• Respect yourself. Respect each other. Respect the staff and volunteers. We are a community family.
• Always be honest. If you need help or advice with a situation, please speak with a staff member or volunteer. We are here to help.
• Treat the furniture, equipment and facility with care and respect. Please clean up after yourself.
• Be sensitive to others in the building by keeping noise minimal and by walking, not running, in the common areas.
• Tobacco products, vape devices, and cartridges are not allowed at the center and if found will be confiscated and destroyed.
• Please always use appropriate language when you are anywhere in the Community Center.
• The staff and volunteers are here to make your time with us as enjoyable as possible. Please follow their instructions and respect the Code of Conduct to guarantee a positive experience for everyone.

I understand that I may lose the privilege to enjoy time at The Route 87 Teen Center either temporarily or permanently by not adhering to this Code of Conduct. I intend to behave in a manner consistent with this Code of Conduct as stated in this document.

Agreed and Accepted by: