COA Club Activity Waiver

COA Club Activity Waiver
COA (Community Outreach Alliance) is a non-profit organization in San Clemente. Our Goal and mission is to offer fun and healthy activities resources to our community that has been deeply affected by the drug and addiction epidemic.

Our clubs are intended for middle schoolers through high schoolers to get together to find something they love to do to stay above the influence.
Event Attending

Music Biking Fishing Volunteering Food Connection Other
Participants Name *

First Name Last Name
Date of Birth *

Month Day Year
Date
Email *
example@example.com
Parent / Guardian Name *

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Emergency Phone Number *

Area Code Phone Number
Date Completed *

Month Day Year
Date
Please Tick to Agree *

I, grant my permission for my child* to being permitted by 'Community Outreach Alliance' to participate in its activities and to use its equipment's and facilities. I further agree to indemnify and hold harmless 'Community Outreach Alliance' from any and all claims which are brought by, or on behalf of my child, and which are in any way connected with such use or participation by my child.
Should be Empty: