Participation Form for Adults

Name *
Name
Address
Address
Phone Number
Phone Number
By typing my name below: I agree to utilize The Shafter Learning Center based on their Computer and Internet Terms of Use and I release of liability the City of Shafter on my behalf. I agree to indemnify and hold the City of Shafter, its officers, directors, agents, employees, representatives and volunteers free and harmless from any loss, liability, damages, costs, or expenses. I also give permission for the Shafter Learning Center to use pictures or video of me in promotional materials. I authorize the Shafter Learning Center to contact me via the contact information I have provided through individual and automated communication.