Pass for Peace Registration Form

Important Notes:

- Free program

- Dates October 25, 2024 and November 4, 2024

- Spots are limited

Participant: Ages 12-15

Dressed in appropriate basketball and/or football clothing and sneakers

West Side Park Community Center

600 S 17th Street, Newark, NJ 07103

United Community Corporation: in consideration of the opportunity afforded to me or my minor child/ward to participate in the activity described in the Registration Form occuring at:

The West Side Park Community Center 600 South 17th Street, Newark, NJ 07103

I, the undersigned, on behalf of myself (18yrs or older) or my child/ward named in the Registration Form, do freely agree to make the following contractual representations and agreements.

I, on behalf of myself or my child/ward named in the Registration Form, acknowledge and understand that participation in the activity involves the risk of serious injury, including permanent disability and/or death and severe social and economic losses.

I, on behalf of myself or my child/ward named in the Registration Form, do hereby knowingly, freely, and voluntarily assume all liability for any damage or injury which may occur as a result of my of child/ward’s participation in such activity and further agree to release, waive, discharge, and covenant not to sue the United Community Corporation, its officers, agents, employees, and volunteers from any and all liability or claims which may be sustained by me, my minor child/ward, or a third party directly or indirectly in conjunction with, or arising out of participation in the activity described herein, whether caused in whole or in part by the negligence of the United Community Corporation or otherwise.

I, on behalf of myself or my child/ward, have read the above provision, fully understand its terms, and understand that I, on behalf of myself or my child/ward, have given up substantial rights by signing this waiver and I acknowledge that I signed it freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of any and all liability to the greatest extent allowed by law and I agree that, if any portion of this Registration Form is held to be invalid, the balance, notwithstanding, shall continue in full force and effect.

DO NOT E-SIGN UNTIL YOU HAVE READ THE ABOVE STATEMENT.

By my eSignature below, I certify that I have read, fully understand and accept all terms of the foregoing statement. Please signify your acceptance by entering your full name in the box below

Photographs/Video/Internet

I hereby give permission for my child’s photograph to be taken and for him/her to be captured on video in connection with the activities of United Community Corporation and to be used in newspaper and magazine articles, on television and other presentations concerning the program, or on the internet. I understand that my child would only be identified by first name, if at all. I understand that my child, identified only by first name or as a member of a group, may also be included on video streams of events over the Internet that are organized and supervised by United Community Corporations’ staff. I give permission for the following information to be made available publicly, at the discretion of United Community Corporation: ● My child’s first name and/or picture ● Video of students in a group ● My child’s intellectual property (such as artwork, poetry, essays, performances, etc.)