Individual Use Waiver

Please fill out the following information: If participant is under the age of 18, a parent and/or guardian must complete this form. If you have competed this form in the past and any of your informatoin has not changed you do not need to complete a new one!

Are you filling out this form for yourself, or for your child? *

Please fill out the following information for your child/children who are planning on participating.

Childs First Name: *

Childs Last Name: *

Age: *

2nd Childs First Name:

2nd Childs Last Name:

Age:

3rd Childs First Name:

3rd Childs Last Name:

Age:

4th Childs First Name:

4th Childs Last Name:

Age:

5th Childs First Name:

5th Childs Last Name:

Age:

Please select which activity/event you or your child is participating in: *

Please specify what group/activity you or your child is participating in *

If signing up for adult open gym, you MUST submit image of license (front and back).***Information on license must match information on individual use form*** *

Please choose one of the below: *

I need to speak to a MYC staff member about volunteering

I have spoken to an MYC staff member about volunteering

First Name of Person Filling Out This Form *

Last Name of Person Filling Out This Form *

Age: *

Email Address *

Phone Number *

Street Address *

Address Line 2

City *

State *

Zip Code *

Mobile Phone Number *

Please complete the following contact information for an emergecny contact (other than participant/guardian above):

First Name Of Emergency Contact *

Last Name of Emergency Contact *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Please complete below if you are filling out this form for your child/children:

Please read each statement noting that you have read and agree to the terms of use:

Please be reminded that NO FOOD OR DRINK (except water) is allowed into the gymnasium, game room, computer lab without the permission of the Director.
You are responsible for any damage to Milford Youth Center equipment caused by improper handling or carelessness.
In the event of any damage to building (ex, gymnasium floor, graffiti, etc.), from whatever cause, the individual and/or group organizer will be fully responsible for the cost of any and all repairs or replacement.
The program organizer(s), group chaperones, the Milford Youth Commission, the town of Milford and their respective employees and agents shall not be liable for any personal injury (including death), damages, or loss to my person or property arising from my participation in this program. It is further agreed that in consideration of being so permitted to participate, (I)(we) do forever release, acquit, discharge and covenant to hold harmless the Milford Youth Commission and the Town of Milford, and their successors, departments, officers, employees, servants, and agents, of and from any and all actions, causes of action, claims, demands, damages, costs, loss of services, expenses and compensation on account of, or in any way growing out of, directly or indirectly all known and unknown personal injury or property damage which may hereafter occur, and also any claims or rights of actions for damages which have or hereafter may acquire, resulting from participation in the subject excursion.

To the greatest extent permitted by law, the Participant or Parent/Guardian whose signature is below, agrees to defend, indemnify and hold harmless the Owner, the Town of Milford, and its agents, servants, employees, successors, heirs, executors, insurers, attorneys, administrators and all other representatives, of and from any and all claims, liabilities and actions for damages or other relief, whether sounding in contract, tort, or otherwise, on account of or in any way arising out of and/or relating to the aforementioned self or child(ren)'s use of the property, including but not limited to incidents involving the Owner’s negligence. The duty to defend shall immediately accrue and be owing upon the utterance of such a claim by any person or entity regardless of merit and shall not be dependent upon a finding of negligence or any other finding of fact at trial. The duty to defend shall be absolute and will include and shall not be defeated or in any way undermined by the utterance of claims not covered by this agreement.

Date: * +

The signing of this form shall constitute an agreement to all regulations governing use of Town of Milford facilities and to accept full responsibility for damage to or loss of municipal property and for payment of all fees assessed for such use. *

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Photo Release

I understand that my/my child(ren)’s name and photo may be used in photographs, videos, literature, web pages, and news releases in local papers and other media outlets. I, the aforementioned Participant or Parent/Guardian, give permission for my or my son/daughter(s) to be photographed and named for MYC rental for the Milford Youth Center. *

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Milford Youth Center Agreement- COVID-19 Compliance Form

** All guidelines subject to change upon Town & State regulations **

Please read each statement and sign below as you will be responsible to followed these guidelines while at the Milford Youth Center.

I have read and understand all COVID-19 protocols and will communicate with MYC if there are any concerns or failures to comply. *

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-Facility will be locked so please utilize the intercom to have the door opened. Program participants must sign in as they enter the facility, while practicing social distancing.

-Face masks are currently optional. *This is subject to change at any point per Board of Health guidelines*

-Participants are asked to utilize sanitation table before entering the gymnasium.

-Individuals/players are recommended maintain 3 feet of distance outside of contact drills.

-Bottle filling stations and water fountains are available for use.

-No recreational play or loitering berfore, during or after each rental.

-Spectators are allowed at the discretion of the Renter running the program and/or with COVID policy changes.

-To participate or attend, participant must make sure they show no signs or symptoms of COVID-19 for 5 days. If an individual develops symptoms of COVID-19 duing the activity, they should promply inform the facility staff and must be removed from the activity and will be instructed to return home.

-If a participant tests positive for COVID-19 within 5 days of being at the Milford Youth Center, it is the responsibility of the parent to let the organizer of the rental as well as the Milford Youth Center know.

-Participant should assess the cleanliness and disinfection protocols at the facility. If cleanliness is low, or any other concerns arise, participant should let a facility member know.

-When scrimmaging or doing close contact drills, gym windows must be open to increase air flow within the gymnasium (temperature permitting).