Current/Returning Participants paying with cash, check, Sparc Credit

Participant First & Last Name:(Required)

Parent/ Guardian Name:(Required)

Email Address:(Required)

Phone Number:(Required)

Weekend Adventures Events (Please include whether it's Respite or Non-Respite):

If yes, please share your new details. (ie: address, phone number, emergency contact, etc):

If yes, please share your new details and any other information we should know about the participant:

PARTICIPATION: I electronically consent to the following permission for the participant being registered: * to actively participate in activities as registered on this form * to be transported and given emergency medical treatment y in case of injury * for SPARC to communicate with me regarding my child/participant by phone, email, or text * my electronic signature is valid for ongoing enrollment in SPARC unless otherwise indicated.(Required)

(By typing your name above you are consenting to the terms)

By participating in a SPARC program, the parent/guardian of each participant and the participant agree to indemnify, release and hold harmless SPARC, its officers, directors, employees, consultants, agents (including independent contractors, if applicable), and volunteers from any and all liability or causes of action whatsoever arising out of, or which may result from such participation.(Required)

(By typing your name above you are consenting to the terms)

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Current/Returning Participants paying with cash, check, Sparc Credit

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