Skip to Main Content
How Do I...
Select a Category
Holiday Home Decorating Contest
Photo Contest Entry Form
Small Business Relief Fund- Grant Application
signing in or creating an account
, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
Sign in to Save Progress
USTA Florida Girls 12-14 Clay Courts Tournament Waiver
This form has been modified since it was saved. Please review all fields before submitting.
I/We hereby consent to: my/ourand/ormy/ourchild/childrens’ participation in any "Recreational Activity" of the City of Palm Beach Gardens.I/We acknowledge and understand that we may be participating in activities which involve the risk of injury/death, including transportation to and from program activities, and that there are some risks that cannot be foreseen or anticipated at this time. In consideration of the City’s consent to my/our participation in the Program and other good and valuable consideration, the receipt of which is hereby acknowledged, I/we hereby release and agree to hold harmless for any foreseen or unforeseen and associated risks, the City of Palm beach Gardens and its officers, agents and employees, volunteers, independent contractors, vendors and/or participants, from any and all losses, claims, damages, liabilities, and causes of action that I/we may have, and which our minor child/children may have, as a result of injury or death, or damage to personal property, which may occur during our and my/our child/children’s participation in the program, specifically including but not limited to transportation to and from Program activities. I/We agree and acknowledge that this Release will apply and include claims regardless of the City’s own negligence, and is intended to be as broad and inclusive as permitted by the laws of the State of Florida. I/WE FURTHER ACKNOWLEDGE THE CONTAGIOUS NATURE OF COVID-19 AND THAT THE MERE PRESENCE OF ME, US, AND/OR MY CHILD(REN) AT CITY FACILITIES AND MY/OUR/THEIR PARTICIPATION IN CITY RECREATION ACTIVITY MAY RESULT IN MY, OUR, AND/OR MY CHILDREN’S(S’) PERSONAL INJURY, ILLNESS, PERMANENT DISABILITY, AND/OR DEATH. I/We further acknowledge and understand that the City does not provide accident or medical insurance for us or our children in connection with this Program, and I/we agree to accept full responsibility for all medical costs and expenses of ourselves and our children which may arise, and I/we release the City from all claims which I/we may have for the payment of medical expenses or the reimbursement of medical expenses for ourselves and our children. In the event of an emergency during my/our or my/our child/children's participation in the program, I/we consent to the emergency medical treatment of my child/children at the nearest hospital, medical center or by the emergency medical response services unit at the scene. I/We understand and agree that the City has the right to dismiss, expel, or suspend us or our children from the Program if the City, in its sole discretion, determines that we or our children's behavior is unruly, violent, or otherwise disruptive of, or detrimental to, the Program. I/we understand that no refunds or fees paid for the program will be given in the event of the expulsion or suspension. I/We acknowledge and understand that photographs of participants, in the Program may be taken and used by the City on the City's website or in other City publications, and I/we hereby expressly consent to the use of our and our children's name, photograph or other likeness in this regard.
I/We have read and understand this document and I/we voluntarily agree to all the terms and conditions of this Agreement.
Participant Full Name
Parent/Guardian Full Name
Leave This Blank:
Receive an email copy of this form.
This field is not part of the form submission.
* indicates a required field
Fee Schedule (PDF)
Slideshow Left Arrow
Slideshow Right Arrow