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Fall 2023 CERT Training Application

  1. Participants must be a resident of Rancho Santa Margarita 

  2. I certify or affirm:*
  3. Previous Experience

    Please check all that apply

  4. RELEASE AND WAIVER OF LIABILITY Electronic Signature Agreement*

    ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT ("Release and Waiver"). In consideration of permission from the City of Rancho Santa Margarita ("City") for the person(s) listed as the participant(s) below ("Participant") to participate in these recreational activities, I agree to the fullest extent permitted by law to indemnify, defend, release, waive, and hold harmless the City, its elected and appointed officers and officials, employees, agents, volunteers, and representatives (collectively, the “Indemnitees”), from any and all liability or claim, action, suit, judgment, or other proceeding resulting from any loss, damage, illness, injury, or death to the Participant, or damage to property (collectively, "Claims") pertaining to, related to, or arising out of directly or indirectly the Participant's registration and participation in these recreational activities, including all acts of negligence of the Indemnitees; provided however that this Release and Waiver shall not apply to the extent that such Claims are attributable to the gross negligence or willful misconduct of the Indemnitees. I agree that this Release and Waiver shall be binding upon the Participant and our personal representatives, children, successors, assigns, and heirs and shall apply as well to all conduct of persons other than the Indemnitees, including but not limited to, other participants in these recreational activities.

    I understand that participation in these recreational activities by the Participant involves risk of injury or death to the Participant and injury to property, and I hereby agree to assume all such risks, both known and unknown, including risks associated with the Indemnitees' failure to maintain, inspect, supervise, or control equipment and facilities or failure to warn of or repair dangerous conditions of property. I further understand the nature and risks of participation in these recreational activities, and I hereby represent and warrant that the Participant does not have any medical conditions or other health conditions that would preclude or limit the Participant's participation.

    I further acknowledge and agree that the Indemnitees and others, including but not limited to, the Orange County Fire Authority, may render first aid or other medical treatment to the Participant in the event of any injury to the Participant, and that in the event of an injury to the Participant, I hereby authorize the Indemnitees and others, as deemed necessary, to provide first aid or medical treatment to the Participant. I acknowledge and agree that this Release and Waiver is inclusive of any and all Claims pertaining to, related to, or arising out of directly or indirectly the rendering of first aid or medical treatment to the Participant.

    Photo Release. I authorize the Indemnitees to, without charge, take and use video and photographs of the Participant to publicize the City's recreational programs and for advertisement or other related purposes, and I consent to the use of the Participant's likeness, name, voice, and words for such purposes.

    Applicable if Participant is a Minor. I am the parent/legal guardian of the Participant(s), and I hereby execute this Release and Waiver on his or her behalf.

    By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending the Bell Tower Regional Community Center and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 by attending the program and activities may result from the actions, omissions, or negligence of myself and others, including, but not limited to, City employees, volunteers, and program participants and their families.

    I CERTIFY THAT I HAVE BEEN PROVIDED WITH A FULL OPPORTUNITY TO READ THIS RELEASE AND WAIVER, HAVE DONE SO AND AM EXECUTING IT VOLUNTARILY WITH FULL KNOWLEDGE AND UNDERSTANDING OF ITS CONTENTS WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE, AND INTEND THAT IN SIGNING THIS RELEASE AND WAIVER TO HAVE IT APPLY TO THE FULLEST EXTENT PERMITTED BY LAW.

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

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