A collaboration between Two Peaks Fitness, La Veta Public Library, and La Veta Public Schools You need not be enrolled in La Veta Public Schools to participate. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Child's Name *Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Grade 2023-2024 *Parent's Name *Address *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Phone *Special Medical Needs/AllergiesCONSENT TO EMERGENCY TREATMENT WE HEREBY AGREE NOT TO HOLD EMPLOYEES, AGENTS, VOLUNTEERS, OR INSURERS OF TWO PEAKS FITNESS INC., LA VETA PUBLIC LIBRARY, OR LA VETA PUBLIC SCHOOLS/RE-2, LIABLE FOR THE PROVISION OF EMERGENCY SERVICES TO MY/OUR CHILD IN CONNECTION WITH MY/OUR CHILD'S PARTICIPATION IN THE TWO PEAKS FITNESS/LA VETA PUBLIC LIBRARY/LA VETA PUBLIC SCHOOLS AFTER SCHOOL ENRICHMENT PROGRAM. I have read and agree to abide by policies set for by Two Peaks Fitness Inc., La Veta Public Libraries, and La Veta Public Schools regarding payment, facility and drop-off policy, etiquette, and proper attire. I allow Two Peaks, La Veta Public Library, and/or La Veta Public Schools to use my child’s name and/or photographic likeness in all forms and media for advertising, trade or any other lawful purpose. Enrollment fee (includes convenience fee): $31.21 All registrations and payments must be received by Two Peaks Fitness no later than the end of the first week of the session. NO REFUNDS. Emergency Treatment and Policies - Parent or Guardian Consent * Clear Signature Date *ACTIVITY WAIVERRELEASE OF LIABILTITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS, AND INDEMNITY AGREEMENT (hereinafter referred to as the "Release Agreement") Name *FirstLastAddressAddress Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeAgeTWO PEAKS FITNESS INC., LA VETA PUBLIC LIBRARY DISTRICT, AND LA VETA SCHOOLS/RE2 (to be referred to as "organization") and its (their) directors, officers, employees, instructors, guides, agents, representatives, independent contractors, subcontractors, suppliers, sponsors, successors and assigns (all of whom are hereinafter referred as "the Releasees") "ACTIVITY": AFTER SCHOOL ENRICHMENT (to be referred to as "ACTIVITY" in this document) DEFINITION In this Release Agreement, the term “ACTIVITIES” shall include all activities, events or services provided, arranged, organized, conducted, sponsored or authorized by the Releasees and shall include, but is not limited to: “ACTIVITY”; “ACTIVITY” rental; orientational, and instructional courses, seminars and sessions; travel, transport and accommodation; and other such activities, events and services in any way connected with or related to “ACTIVITY”. ASSUMPTION OF RISKS In consideration for permitting me/my child/ward to participate in “ACTIVITY”, I voluntarily agree, for myself, my heirs, executors, and administrators, to the following: RELEASE OF LIABILITY, WAIVER OF CLAIMS, AND INDEMNITY AGREEMENT In consideration of the RELEASEES agreeing to my participation in “ACTIVITY” and permitting my use of their services, equipment and other facilities, and for other good and valuable consideration, the receipt and sufficiency of which is acknowledged, I hereby agree as follows: TO WAIVE ANY AND ALL CLAIMS that I have or may in the future have against the RELEASEES AND TO RELEASE THE RELEASEES from any and all liability for any loss, damage, expense or injury, including death, that I may suffer or that my next of kin may suffer, as a result of my participation in "ACTIVITY" DUE TO ANY CAUSE WHATSOEVER, INCLUDING NEGLIGENCE, BREACH OF CONTRACT, OR BREACH OF ANY STATUTORY OR ANY OTHER DUTY OR CARE, INCLUDING ANY DUTY OF CARE OWED UNDER THE OCCUPIERS LIABILITY ACT, ON THE PART OF THE RELEASEES, AND FURTHER INCLUDING THE FAILURE ON THE PART OF THE RELEASEES TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS, AND HAZARDS OF PARTICIPATING IN "ACTIVITY" REFERRED TO ABOVE; TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES for any and all liability for any property damage, loss, or personal injury to any third party resulting from my participation in "ACTIVITY"; That I have medical insurance and will show proof of insurance; This Release Agreement shall be effective and binding upon my heirs, next of kin, executors, administrators, assigns and representatives, in the event of my death or incapacity; This Release Agreement and any rights, duties and obligations as between the parties to this Release Agreement shall be governed by and interpreted solely in accordance with the laws of the State of Colorado and no other jurisdiction; and Any claim or litigation involving the parties to this Release Agreement shall be made solely under the laws of the State of Colorado and shall be brought only in the Huerfano County Court or the District Court in and for Huerfano County, Colorado. In entering into this Release Agreement, I am not relying on any oral or written representations or statements made by the Releasees with respect to the safety of participating in “ACTIVITY”, other than what is set forth in this Release Agreement. I CONFIRM THAT I HAVE READ AND UNDERSTOOD THIS RELEASE AGREEMENT PRIOR TO SIGNING IT, AND I AM AWARE THAT BY SIGNING THIS RELEASE AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS, ASSIGNS AND REPRESENTATIVES MAY HAVE AGAINST THE RELEASEES. Activity Waiver - Signature of Participant * Clear Signature Name *Activity Waiver - Signature of Guardian if Participant is under the age of 18 Clear Signature Please pay by debit/credit card or call 719-742-3555 for scholarship information. Registration fee per child, including convenience feePrice: $31.21SquareCardName on CardScholarship Coupon Code Apply SubmitSave and Resume Later Your form entry has been saved and a unique link has been created that you can access to resume this form. Enter your email address to receive the link via email. Alternatively, you can copy and save the link below. Please note, this link should not be shared and will expire in 30 days, afterwards this entry will be deleted. Copy Link Email * Send Link