Guest pass and waiver Guest pass and waiver Guest waiver for visitors accompanying a member Name of hosting member(Required) First Last Member phone(Required)Member email(Required) Membership number of host(Required) Date(Required) MM slash DD slash YYYY Digital signature(Required) Guest informationList names and ages of visitors(Required) Add RemoveConsent(Required) I agree to the visitation policy.In consideration of being allowed to participate in the activities and programs of the Levite Jewish Community Center and to use its facilities, equipment, and machinery, and in addition to the payment of any fee or charge, I do hereby waive, release, and forever discharge the LJCC and its officers, agent, employees, representatives, executors, and all others from any and all responsibility or liability from injuries or damages resulting from my or my children’s participation in any activities, or my or my children’s use of equipment or machinery and any others acting upon their behalf from any responsibility or liability for any injury or damage to myself or my children, including those caused by the negligent act or omission of any of those mentioned or others acting on their behalf or in any way arising out of or connected with my or my children’s participation in any LJCC activities or use of any LJCC equipment. I agree to abide by all LJCC policies and procedures as a facility guest. I further certify that I am the parent or legal guardian of the child/children listed on this agreement or that I have been granted power of attorney to sign this agreement on behalf of the parent or legal guardian of the child/children listed. Consent(Required) I agree to the liability policy.I agree that I shall be solely liable for any and all actions, causes of actions, penalties, claims, costs, services, compensation, or the like resulting from this misrepresentation, and I agree to be contractually bound by this certification. Digital signature of parent/legal guardian/participating adult(Required) Phone of parent/legal guardian/participating adult(Required)AuthorizationDigital signature of authorized LJCC staff member(Required) Δ
