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WAIVER AND RELEASE OF LIABILITY: I understand that the activities, services, trips, and events offered by the Parker Senior Center (PSC)

may have an element of hazard or inherent danger, and further may be an extreme test of a person’s physical and mental abilities. I understand that

my participation in such activities, services, trips and events can cause serious injury, potential death, and property damage. I further understand

participating in activities and trips while in a wheelchair may present special hazards, inherent danger, and be an extreme test of physical abilities.

With full understanding of the potential risks, I hereby assume the risks of participating in activities, services, trips, and events offered by the PSC. On

behalf of myself, my executors, administrators, heirs, next of kin, successors and assigns, I hereby waive, release, and discharge the PSC, its officers,

directors, employees, and volunteers from any and all claims, liabilities, losses, costs, or expenses, for death, personal injury, or damages of any kind

that I may incur while participating in or traveling to and from PSC activities, services, trips and events, whether such losses, damages or injuries are a

result of negligence of PSC, its officers, directors, employees, and volunteers except for loss, damage, or injury which is the result of gross negligence

and/or wanton misconduct of PSC, its officers, directors, employees, and volunteers. I agree to indemnify and hold harmless PSC, its officers,

directors, employees, and volunteers from any claims made or liabilities assessed against them as a result of my actions, or any action taken on my

behalf.

In consideration of the rights and privileges granted to me by my involvement with the PSC, I certify that I have read and understand the above

WAIVER AND RELEASE OF LIABILITY and that I understand that I have given up substantial rights by signing this document, and hereby acknowledge

that I am signing voluntarily. I also understand and agree that my photograph may be taken while participating in PSC activities, services, trips and

events and such photograph may be used in publications and for promotional purposes and I will not be compensated for the use of my photograph.

As a member of the Parker Senior Center, I will adhere to the “Code of Conduct” asset forth in the Bylaws.

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Center Staff will verify membership information and get your signature, to have on file with this online form