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2. 
6. Spend a warm summer evening at Purissima Park for an outdoor dinner and movie experience. Prior to the movie, set up camp at the park to enjoy Latin American inspired food fusions (not included) from a local food truck. At sunset, Disney’s Encanto will be displayed on a giant outdoor movie screen. Throughout the event, members of the Los Altos Hills Youth Commission will be hosting a coffee and hot cocoa bar along with serving guests their buttery popcorn.
10. Name*
11. # People In Party*
12. Email*
14. How did you hear about this event?

    1. Activity Guide
    2. Town Website
    3. Social Media
    4. Flyer
    5. Personal Invitation
    6. Other
15. Resident of Los Altos Hills? *

    1. YES
    2. NO
16. Do you plan to purchase food? *

    1. YES
    2. YES
20. Release of Liability & Assumption of Risk Agreement

    In consideration of the acceptance of the application for entry into the classes or activities listed, I hereby waive, release and discharge any and all claims for damages for death, personal injury, or property damage which I may have, or which may hereafter accrue to me as a result of my participation in said classes or activities.

    I am aware that these classes or activities subject me to physical risks and dangers, nevertheless, I voluntarily agree to assume any and all risks of injury or death, and to release, discharge, and hold harmless all of the entities or persons mentioned above who, through negligence or carelessness, might otherwise be liable to me, or my heirs, personal representatives, next of kin, spouse or assigns.  It is understood and agreed that this waiver, release, and assumption of risk is to be binding on my heirs, personal representatives, next of kin, spouse and assigns. 

    I have fully read this Agreement and fully understand its content.  Furthermore, the significance of this release of liability and assumption of risk agreement has been EXPLAINED TO THE MINOR.

    In addition, should the Town of Los Altos Hills and/or its representatives take photographs of my or my child’s program, event or activity, I agree to allow the use of my and or my child’s photograph for program publicity purposes only.

22. Electronic Signature Agreement*

    1. I agree.
24. Electronic Signature*
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26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field