COA Activity & Volunteer Waiver

COA Activity & Volunteer Waiver
COA (Community Outreach Alliance) is a non-profit organization in San Clemente. We offer music activities and food for those in need, as well as resources to our community that has been deeply affected by the drug and addiction epidemic
Event Attending

MusicVolunteering Food Connection
Participants Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Parent / Guardian Name ( if under 18)

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Phone Number*

Area CodePhone Number
Date Completed*

MonthDayYear
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: