July 6-August 13, 2021 Free summer activities right in your neighborhood! Register now for a summer of fun! It’s totally free and includes lunch! Playground Program Child's Name* First Last Location*Select which Playground you will be attending. Park Avenue Playground (North Hill) Muff Sallie Playground (South Side) Farrell Playground (East Side) Bollinger Playground (West Side) Parent Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent Phone*Email* Allergies & Special NeedsIs there anything we need to know about your child?Race/Ethnicity Caucasian Black Asian Hispanic Prefer not to say Other Gender Male Female ReleasesCovid Release*The Playground Program Partners are committed to take precautions against COVID-19. By checking below, I agree to the following: • I understand the above symptoms and affirm that my child, as well as all household members, does not currently have, nor have experienced the symptoms of COVID-19 within the last 14 days. • I affirm that my child, as well as all household members, has not been diagnosed with COVID-19 within the past 30 days. • I affirm that my child, as well as all household members, has not knowingly been exposed to anyone diagnosed with COVID-19 within the past 30 days. • I affirm that my child, as well as all household members, have not traveled outside of the country or to any city considered to be a “hot spot” for COVID-19 infections within the past 30-days. By checking below, I agree to each statement above and release Arts & Education at the Hoyt, Lawrence County YMCA, LCCAP, Lawrence County Crisis Shelter, New Castle Public Library, the New Castle Police Department and the City of New Castle from any and all liability for unintentional exposure or harm due to COVID-19. I agreeLiability Waiver*I hereby certify that I am the parent or legal guardian of the participant and grant permission for my son/daughter to attend the Playground program that I am registering for. I release – for myself and my heirs, executors, administrators, legal representatives, assigns, and successors in interest, and for my child - Arts & Education at the Hoyt, Lawrence County YMCA, LCCAP, Lawrence County Crisis Shelter, New Castle Public Library, the New Castle Police Department and the City of New Castle and all other staff members, interns, organizers, and volunteers of this program, and the officers, directors, shareholders and/or members, agents and employees of each from any and all rights, claims, or liability for damage for any and all injuries to my child, or my or their property arising out of or in connection with my participation in this program, including but not limited to CLAIMS ARISING FROM THE NEGLIGENCE OF THE RELEASED PARTIES and claims for damage caused by me, my child, or anyone else [including acts of God]. I PROMISE NOT TO SUE THE RELEASED PARTIES on behalf of me or my child regarding any claim arising from my and/or my child’s participation in the Playground Program. I further agree that I WILL DEFEND, INDEMNIFY, AND HOLD HARMLESS, the Released Parties against all claims, demands and causes of action, including court costs and reasonable attorneys’ fees, directly or indirectly arising from any action or other proceeding brought by or prosecuted contrary to this Agreement for the benefit of me or my child. By checking below, I agree to these terms. I agreePhoto Release*I give my permission for Arts & Education at the Hoyt, Lawrence County YMCA, LCCAP, Lawrence County Crisis Shelter, New Castle Public Library, the New Castle Police Department and the City of New Castle to use images and videos of my child for use on their organization’s website, social media pages, and other marketing materials. I give permission for my child to be photographed. I DO NOT give permission for my child to be photographed.