Circle Of Parents Registration

First Name

Last Name

Home Phone Number

Email Address

Zip Code

How did you learn about this Circle of Parents Group?

Gender Identity

Racial Identity

Are you of Hispanic, Spanish, or Latino Origin?

Sexual Orientation

Marital Status

Primary Language

Do you have any food allergies? (Select all that apply)

Do you need any accommodations for vision, hearing, or mobility to participate in the class?

Total number of children currently in your care

0-2 years old

3-5 years old

6-12 years old

13-18 years old

Total number of children ever in your care ( current and previous)

Participating Child(ren)

First Name of Participating Child

Last Name of Participating Child

Child's Birthdate

Child's relationship with participating adult

Does this child have any food allergies? (Select all that apply)

Waivers and Covid-19 Information

By selecting "I Accept" using any device, means or action, you consent to the legally binding terms and conditions of these Agreements. You further agree that your signature on this document is as valid as if you signed the document in writing.

Media Release

I consent to and allow Mountain Resource Center to use and reproduce any and all photographs or videotapes taken of me during my participation in Family Education Programs. I understand that Mountain Resource Center will own the photographs and video and the right to use or reproduce such photographs and videos in any media, and the right to edit them or prepare derivative works for purposes of promotion, advertising and public relations. I hereby consent to Mountain Resource Center’s use of my name, likeness or voice, and I agree that such use will not result in any liability to these parties for payment to any person or organization including myself.

I ACCEPT

Liability Waiver

I understand the risks, hazards, and dangers inherent in carrying out normal day-to-day activities while participating in Family Education Programs. I agree for myself and my heirs, to release and hold harmless, defend and indemnify the Mountain Resource Center and Illuminate Colorado, its trustees, officers, agents, employees, and volunteers, from and against all claims, demands, actions, and causes of action as a result of personal injury, death, or property damage sustained by me or by others due to this activity.

I ACCEPT

Covid-19 Waiver and Guidelines

I understand and assume the risk that, despite MRC’s best efforts to prevent spread of the illness, I may become ill from COVID-19 and such illness may result in serious illness, up to and including death. I hereby assume the risk of bodily injury, illness, death, medical treatment, and property damage resulting from attending Circle Of Parents. I hereby release, discharge and agree to indemnify and hold the Mountain Resource Center harmless from, and waive on behalf of myself and my heirs and personal representatives and any minors I am responsible for who attend with me, any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the Mountain Resource Center, or that may otherwise arise in any way in connection with any voluntary activities with, or for Mountain Resource Center. I will follow general CDC and the State of CO health guidelines by:

-Having not traveled internationally in the past 14 days or to a highly-impacted area within the United States in the past 14 days before attending Culinary Adventures.

- To the best of my knowledge, I have not been exposed to a person with a confirmed or suspected case of COVID-19 within fourteen days of attending Culinary Adventures.

- I have not been diagnosed with COVID-19; or, I have been diagnosed with COVID-19 and I have been symptom free without the aid of any medications for more than 72 hours.

- I understand that my temperature may be taken by someone from MRC before Culinary Adventures begin.

-I will follow recommended CDC and state guidelines - practicing social distancing by participating in group activities of fewer than 10 people, trying to maintain separation of six feet from others, and otherwise limiting my exposure to the coronavirus.

-I will wear a mask or face covering while participating in any activity.

I ACCEPT

Electronic Signature

Contact Information