14. KaBoom! Inc. playgroundCUPERTINO
flEPARTMENT OF' PARKS AND RECREATION
CITY HALL
10300 TORRE AVI=NUE • CUPERTINO, CA 95014-3255
TELEPHONE: (40E3) 777-311 O • >=AX: (408) 777-3366
STANF REPORT
Agenda Item No. ~`"
SUBJECT AND ISSUE
MEETING DATE: April 7, 2009
Authorize the City Manager to negotiate and execute a contract with KaBoom, Inc. in the amount
of $63,400 for the construction of a playground at Blackberry Farm.
BACKGROUND
Phase 1B of the Stevens Creek Corridor project includes repair and renovation of some of the
facilities at Blackberry Farm. The playground. at Blackberry Farm was removed due to its
condition. Anew playground was scheduled to be constructed in Phase 1B.
KaBoom! Inc. is anon-profit organization than works with communities to build playgrounds.
The KaBoom process involves hundreds of conlrnuruty members who build a playground in one
day. KaBoom has helped build over 1500 playgrounds throughout the United States.
DISCUSSION
Working with KaBoom provides Cupertino with a unique opportunity to strengthen community
relationships and make the Cupertino commuiuty more aware of the Stevens Creek Corridor Project
and Blackberry Farm.
The Cupertino Rotary is also a partner with this project and is contributing $10,000 as well as
volunteers. The City has invited other service clubs to participate. The build day is Saturday, June--
6, at Blackberry Farm.
We anticipate some 200 volunteers working under the direction of KaBoom on June 6 to construct
this new playground. The playground will be in the same location of the original playground.
Build day will include food, music, and activities for children.
Through our Leadership and Learning Partnership with De Anza College, two classes are making
the KaBoom build their service learning project. Under the guidance of Block Leader To~43~er,
the students will be canvassing the neighborhood around Blackberry Farm to invite the neighbors to
participate on Build Day and to come to the July 4 Grand Opening. The students will also
participate in the Build Day.
The contract with KaBoom has the City assuming all of the liability. KaBoom will not change the
contract language. Staff believes the community benefit of the project overrides the potential
liability. KaBoom has not experienced claims or lawsuits at its 1500 other sites. The City has
assumes full liability with other recreation contracts such as the pool lease agreement with the
Fremont Union High School District to use the Cupertino High School swimming pool.
The contract with KaBoom is attached.
FISCAL IMPACT
Total cost of the project is $73,400. The Cupertino Rotary is providing $10,000 with the remaining
$63,400 coming from the Phase 1B project budget.
COORDINATION
This report was coordinated with the City Attorney.
RECOMMENDATION
Staff recommends that the City Manager be authorized to negotiate and execute a contract with
KaBoom, Inc in the amount of $63,400 for the construction of a playground at Blackberry Farm.
SUBMITTED BY.
~,.
ark finder
Director, Parks and Recreation
APPROVED FOR SUBMISSION BY:
%~/~ ~
David W. Knapp
City Manager
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FUNDING PARTNER PLAYGROUND CONTRACT
March 20, 2009
KaBOOM!, Inc. ("KaBOOM!'~ is pleased that City of Cupertino (°Funding Partner} has agreed to collaborate with KaBOOM! and a
Community Partner (the °Community Partner"} on the creation of a new playground in Cupertino, California (the "Project'. This Funding
Partner Playground Contract (°Agreement"), which sets forth the Fundincl Partner's obligations in connection with the Project and certain
matters on which the parties have agreed, will, when executed by the duly authorized representatives of each party, supersede any prior
agreements and represent the complete {egaily binding agreement between the parties.
Obligations of KaBOOMl.
(a) Project Management. KaBOOM! shall manage the overall execution of the Project on behaff of the Funding Partner. KaBOOM!
shall assign a project manager who shall supervise the plannirn3 and installation of the playground, including overseeing a "Design
Day' event, presenting playground designs, convening committee conference calls, assuring that the necessary materials, tools and
equipment are on hand and managing the one-day playground installation event, which is referred to as the 'Build Day° and which is
scheduled to occur on June 6~, 2009
(b) Vendors. KaBOOM! shall select and manage vendors that will provide necessary equipment for the playground (e.g., surtacing,
playground equipment, peripheral projects, landscaping, etc.). KaBOOMI shall use commercially reasonable efforts to guard
against any loss to the Funding Partner through the failure of suppliers to properly honor their commitments, but KaBOOM! shall not
be held responsible for any such failure on their part.
(c) Inspection. KaBOOM!, in collaboration with the Funding Partner, will secure a Certified Playground Safety Inspector to review the
playground structure at the conclusion of the Build Day (or, ff KaBOOM! assumes responsibility for the playground construction
going beyond one day, at the conclusion of the installation) to ensure that the structure is safe and built to all appropriate standards
and guidelines, unless the Project is not completed on the Builci Day due to failure of the Funding Partner, in which case the
Funding Partner shall secure the Certified Playground Safety Inspector.
(d) Warranty. Ka800M! will obtain a warranty from the playground equipment manufacturers that all equipment meets or exceeds
current government-approved safety standards. Obtaining such warranty shall be the total extent of the liability of KaBOOM! to the
Funding Partner with respect to the playground equipment, and the Funding Partner agrees that KaBOOM! has not made nor is it in
any manner responsible or liable for any warranty, representation, or guarantee, express or implied, in fact or in taw, relative to any
playground equipment, including without limitation the quality, rnechanical condition or fitness for a particular purpose of the
playground equipment. Any and all warranties and/or guarantees on playground equipment are subject to the respective
manufacturers' terms and therefore, the Funding Partner agrees to look solely to such manufacturers for any such warranty and/or
guarantee.
(e) Insurance. KaBOOM! represents and-warrants it has, and, upon request, shall provide evidence of, the following insurance
coverage: Commercial General Liability with a limit of $1,O~,Ci00 per occurrence with a general aggregate limit of $2,000,000 and
umbrella coverage of at least $1,000,000 per occurrence; Wor4:ers' Compensation with statutory limits for the state in which the work
is performed and employers liability insurance with a minimum of $500,0[10 per accident; and Automobile Liability for owned, hired
and non-owned autos with a combined single limit of $1,000,OCiO. KaBOOM! shall require that any subcontractor hold and maintain
insurance coverage that includes Commercial General Liability and Worker's Compensation coverage of at least the levels held by
KaBOOM 1.
(f) Build Guild. KaBOOM! will place the playground on the roster ~~f KaBOOM! Build Guild and KaBOOM! will send information to the
Funding Partner on playground maintenance programming and enhancements.
2. Obligations of the Funding Partner.
(a) Project Site.
(i) Ownership. At the time of execution of this agreement, tine Funding Partner shall provide KaBOOM! with proof of !and
ownership evidenced by either a deed granting title to the: property to the Funding Partner or a letter from the property owner
showing approval for the Project. Funding Partner will allow the playground to be constructed on its property, will participate in
the organization and planning process and will be the owner of the playground in its entirety, including the equipment and
safety surfacing, and subsequent maintenance. The Funding Partner is the owner of the playground in its entirety, for the
lifetime of the playground, including the equipment and/oir safety surtacing purchased by KaBOOM! and/or its funding partners.
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{ii) Permits. The Funding Partner shall obtain all necessary permits and licenses regarding the installation, possession and use of
the playground prior to Build Day in compliance with local and state laws, regulations and guidelines.
(iii) Preparation. The Funding Partner shall ensure that the playground site is safe for volunteers and children, which responsibility
includes, without limitation: (1) preparing the site for the installation of the new playground at least two weeks before Build
Day, which includes but is not limited to removing existing playground-equipment, footers and safety surfacing, grading the
land, removing fencing and pertorming soil tests; (2) conducting up to two utility checks as reasonably requested by KaBOOMI
with the appropriate utility companies with the first test being completed within two weeks of Design Day and with all utility
check documentation provided to the KaBOOM! Project Manager upon completion; and {3) conducting up to two soil site tests
as reasonably requested by KaBOOM!, with the first test being completed within two weeks of Design Day and with all soil
check documentation provided to the KaBOOM! Project Manager upon completion. The Funding Partner is responsible for
undertaking any necessary risk mitigation should the soil be deemed unsafe for children and volunteers.
(iv) Safety and Security. The Funding Partner together with the Community Partner is responsible for ensuring the security of
equipment, tools, supp{ies and well being of the adults and children from the beginning of the preparation activities until the
conclusion of Build Day, including any postponement.
(v} Maintenance. The Funding Partner shall collaborate with KaBOOMl during the Project planning process to develop a
maintenance program for the playground and shall maintain the playground and the property before and after the build to
ensure a safe and attractive play space. In addition, the Funding Partner shall accept and maintain engineered wood fiber as
playground safety surfacing, meeting standards established by Consumer Product Safety Commission guidelines, for the
lifetime of the playground. Maintenance of the playground facility and supervision of its use is the sole responsibility of the
Funding Partner. Upon request, the playground equipment and safety surfacing manufacturers, including Playworld Systems,
Inc, will provide guidance and materials for the purpose of developing a maintenance plan for the playground.
{b) Build Dav. The Funding Partner shall recruit 80 adult volunteers from the community to participate in a one-day installation event for
the Project, which is scheduled to occur on June 6~, 2009 and which is referred to herein as the Build Day. On the Build Day, The
Funding Partner shall provide food, water, tools, power, and restroom facilities for all volunteers.
(c) Plavaround Costs. The Funding Partner is solely responsible for and shall hold KaBOOM! and its Community Partner harmless
from any costs beyond the proposed Project budget, including costs incurced by the Community Partner for any prior site
preparation, upgrades or improvements or any equipment or materials purchased to supplement those secured by KaBOOM!.
(d) Warranty. The playground equipment and the safety-surfacing related to the Project may be covered under warranty by the
applicable manufacturers; a copy of which warcanty may be obtained, upon request, from such manufacturers. The Funding Partner
acknowledges that any warranties and/or guarantees on any equipment or material are subject to the respective manufacturer's
terms thereof, and the Funding Partner agrees to look solely to such manufacturers for any such warranty and/or guarantee.
Neither KaBOOM! nor its funding partners nor any of their respective affiliates, directors, officers, managers, partners, members,
shareholders, employees, agents or representatives, have made nor are in any manner responsible or liable for any representation,
warranty or guarantee, express or implied, in fact or in law, relative to any equipment or material, including, without limitation, its
quality, mechanical condition or fitness for a particular purpose.
(e} Insurance. The Funding Partner shalt obtain and maintain from the date of this agreement and for a minimum of one (1) year
thereafter worker's compensation insurance policies and commercial general liability insurance (providing coverage against liability
for bodily injury, death and property damage that may arise out of or be based upon the use of the playground), in each case in
amounts not less than one million dollars ($1,000,000}. At the time of execution of this agreement, the Funding Partner shall
provide to KaBOOM! a copy of a certificate from its insurer indicating the nature, scope, duration and amount of insurance coverage,
and naming KaBOOM! and its funding partners as additional insureds under such policy, which insurance shall be primary over any
other insurance covering KaBOOM! and its funding partners and which policy shall provide that KaBOOM! and its funding partners
be given at least thirty (30) days' prior written notice of any change or cancellation of coverage.
(f1 Indemn~cation. The Funding Partner shall indemnify and hold harmless KaBOOMt, its community partners and their respective
affiliates, directors, officers, managers, partners, members, shareholders, employees, agents and representatives from any and all
losses, liabilities, claims, actions, fees and expenses (including interest and penalties due and payable with respect thereto and
reasonable attomeys' and accountants' fees and any other reasonable out-of-pocket expenses incurred in investigating, preparing,
defending or settling any action), expenses (including attomeys fees and disbursements) in each case that are due and payable,
including any of the foregoing arising under, out of or in connection with any actions associated wish this Project or resulting from the
use of any playground property and equipment, including those for personal injury, death, or property damage, except to the extent
resulting from the willful misconduct of such indemnified person. This provision shall survive any termination or expiration of this
agreement.
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(g) Comoensation.l In consideration for KaBOOM! management cif the Project, the Funding Partner agrees to compensate KaBOOM!
the amount of $63,400 according to the following schedule:
(i) Twenty-five percent {25%) or the total ($15,850) shall be clue within 30 days of signing of this Agreement.
(i'r) Seventy percent (70%) of the total ($44,380} shall be due 45 days prior to the Build Day date.
(iii) Five (5%) of the total ($3,170) shall be due within 15 days of the completion of the playground installation.
(iv) The total of any additional fees and expenses incurred pursuant hereto will be due within 30 days of invoicing.
{v) Pasf-due accounts shall be assessed a monthly finance charge of 1'/z °~6 or the maximum rate allowed by law, whichever is
greater.
(h) Timeline. The Funding Partner will respond to KaBOOM! on ttre dates and times reasonably set forth for the Project.
(i) The Funding Partner will identify its Project market to KaE~00M! at least six months in advance of the Build Day.
(ii) Following the confirmation of the Community Partner by tl~e Funding Partner, the Funding Partner and KaBOOM[ will identify a
Build Day date which shall occur on a mutually agreeable date no later than December 31, 2009.
{i) Additional Materials. If the Funding Partner decides to purchase additional equipment to supplement materials secured by
KaBOOMt through the Project budget, then the Funding Partnisr is responsible for paying for the materials directly. Funding Partner
will hold KaBOOM! harmless of any payments or liability with respect to the additional items ordered.
3. Grant of Promotional Rights. KaBOOM! will provide an opportunity for the Funding Partner and Community Partner names and logos to
appear on the permanent playground site sign and on certain materials developed jointly by KaBOOM! and the Community Partner
pertaining to the Project Funding Partner and Community Partner may create and promote Design Day and Build Day events including
posting banner(s) with Funding and Community Partners name and logo at the Project site..
4. intellectual Property.
(a) The Funding Partner acknowledges and agrees that KaBOOM! is the sole owner of all right, title and interest in and to the name and
mark KaBOOM! (the °Mark") and the tagline °It Starts with a Playground.° (the °Tagline"), each in any form or embodiment, as well
as the designs and logos as specified on the KaBOOM! websii:e at www.kaboom.org/stvte (the °Logos", and together wfth the Mark
and the Tagline (and any successor marks, taglines, or logos), the °KaBOOM! Marks°), as welt as ail goodwill attached or which
shall become attached to any of the foregoing. The Logo is comprised of the Mark and Tagline in a starburst design. On occasion,
the Logo may be used without the Tagline; however, prior written approval of KaBOOM! is required for such use. Guidelines for the
usage of the Logo are available from KaBOOM! or via the inteimet at www.kaboom.oro/style. The Funding Partner further
acknowledges and agrees that, as between the parties, KaBO~OM! is the sole owner of all label designs, product identifications,
artwork, symbols, devices, manuals, guides, inventions, and publications produced as pars of KaBOOM! operations, services, and
programs. The parties acknowledge that KaBOOM! may take ail steps to protect.the KaBOOM! Marks and its other property as
KaBOOM! deems appropriate.
(b) During the term of this contract, KaBOOM! hereby grants to the Funding Partner a limited, non-exclusive, non-transferable, non-
sublicensable, worldwide, royalty-free license to use the KaBC~OM! Marks, and the Funding Partner hereby grants to KaBOOM! a
limited, non-exclusive, non-transferable, non-sublicensable, worldwide, royalty-free license to use the Funding Partner's name,
trademarks, service marks, and logos, solely to promote the Project, including, without limitation, in broadcast, print, and Internet
media and advertising, press releases, and other media materials, internal communications materials, and promotional materials,
but only as provided below. Other than in connection with the materials jointly developed as provided in Section 3, each party will
obtain the prior written approval of the other before using the other party's name, marks, or logos in connection with any publicly
distributed materials, provided that the party whose approval i:a being sought will not unreasonably withhold or delay its approval.
KaBOOM! shall have the right to review and approve the type, manner, location, and duration of any advertisements or promotions
in which the Funding Partner references the KaBOOM! Marks, the Project, or its participation in the Project. All such advertisements
and promotions, inclusive of merchandising, sampling and special events, shall be at the expense and liability of the Funding
Partner.
(c) The Funding Partner shall not manufacture, sell, or distribute, or license or otherwise permit the manufacture, sale or distribution of,
any merchandise that incorporates or includes the KaBOOM! IWarks, without prior written consent of KaBOOM!.
(d) Any use of the KaBOOM! Marks by the Funding Partner will inure to the sole benefd of KaBOOM!. The Funding Partner sfiall not
use the KaBOOM! Marks in any manner that would harm the reputation of KaBOOM! or disparage or negatively reflect upon the
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KaBOOM! Marks. Upon expiration of or termination of this contract for any reason, the Funding Partner shall cease all use of the
KaBOOM! Marks.
Build Dav Postponement. A Build Day shall not be postponed except when weather or other conditions jeopardize the sa#ety of the
volunteers or threaten the structural integrity of the playground. The decision to postpone a Build Day will be made by majority
agreement of the representatives of KaBOOMl, the Funding Partner and the Community Partner, except where such decision must be
made by KaBOOM! on the construction site and representatives of the Funding Partner and the Community Partner are not available for
consultation. In the event that a Build Day is postponed, KaBOOM!, the Funding Partner and the Community Partner shall develop a
plan for rescheduling the Build Day at the next earliest date possible for each party and for allocating additional expenses related to the
rescheduled Build Day. In the event that the date of a Build Day is cancelled or changed solely by the Community Partner, the
Community Partner shall be liable to KaBOOM! and the Funding Partner for any equipment costs, labor, and materials and any additional
expenses related to the Project, such as travel expenses and general supplies.
Termination. In the event that the Funding Partner fails to make the payments required under this Agreement, KaBOOMI may terminate
the Agreement upon written notice to the Funding Partner of such termination. Furthermore, if either party is delayed or prevented from
fulfilling any of its obligations hereunder by any cause beyond its reasonable control, including acts of God, acts or omissions of civil or
military authorities, fire, strike, food, riot, act of terrorism, war, transportation delay, or inability due to such causes to obtain required
tabor, materials or facilities, such party shall not be liable hereunder for such delay or failure and either party may terminate this
Agreement if the other is unable to perform any obligation hereunder for a period longer than ten calendar days due to such force
majeure event, in which case KaBOOM! shall refund to the Funding Partner any amounts paid to KaBOOMl, less expenses already
committed and/or incurred prior to the date of such termination. If, upon termination as provided herein, the sum due KaBOOMI by
Funding Partner exceeds the sum paid to KaBOOM! hereunder, Funding Partner shall pay KaBOOM! for any such additional sum due
upon presentation of appropriate documentation within 30 days of invoice. Except as set forth above, upon any termination, this
Agreement shall become void and have no effect, and no party shall have any liability to the other party, except that nothing herein will
relieve any party from liability for any intentional breach of this Agreement prior to such termination.
General Provisions. Each party has all requisite power and authority, including any necessary approval by its governing body, to execute
and deliver this Agreement, and to perform its obligations hereunder. This Agreement may not be assigned or transferred by either party
without the prior written consent of the other party hereto. This Agreement shall inure to the benefit of and be binding upon the parties
hereto, their respective successors and permitted assigns, and where expressly stated, their affiliates and representatives. This
Agreement shall be governed by and construed under the laws of the State of New York, without regard to conflicts of laws principles to
the extent that the application of the laws of another jurisdiction would be required thereby. This Agreement may be altered, modified or
amended only by a written document signed by both parties. This Agreement may be executed in two or more counterparts, each of
which shall be an original and all of which, when taken Together, shall constitute the same Agreement and may be delivered by facsimile
or electronic mail transmission with the same force and effect as if originally executed copies hereof were delivered. Any notices
required or permitted to be given hereunder shall be sent by certified or registered Unfted States mail, postage prepaid, by personal
delivery addressed to the applicable party or by facsimile or electronic mail transmission (the receipt of which is confirmed) at the
address set forth under such party's signature below.
By executing this Funding Partner Playground Contract where indicated below, each of KaBOOM! and the Funding Partner agrees, as of the
date identified above, to be legally bound by all of the terms and provisions set forth above.
Mark Linder
By:
Name: Mark Linder
Title: Director, Cupertino Parks and Recreation
10300 Torre Avenue
Cupertino, California 95014-3255
T: 408.777.3268
F: 408.777.3366
e-mail: marks@cupertino.org
KaBOOMt, Inc.
By:
Name: Bruce M. Bowman
Title: Chief Operating Officer
4455 Connecticut Avenue, NW, Suite 8100
Washington, DC 20008
T: (202) 464-6061
F:{202)659-0210
e-mail: bbowman@kaboom.org
is-s
1 1 * • - • • - • ~ _
KaBOOM! PLAYGROUND PROJECT -- `/OLUNTEER WAIVER AND RELEASE
This form must be signed by or on behalf of each volunteer who will participate in or otherwise be involved with the
.:onstruction of the Blackberry Farm Playground Build (the "Playground Build" or the "Project"), or will be on the
construction of the Playground Build, occurring the week of June 6th in Cupertino, CA. If you are unable to read this print,
please speak with the person handling volunteer registration for assistance.
The KaBOOMI project and activities will include the playground construction, side projects and play enhancement projects on and in the periphery of
the playground construction site including building interiors. The ^playground construction site° is the physical space where the playground is being
installed; the playground construction projects are any activities directly related to the installation and placement of the playground equipment, the
mixing of concrete and moving safety surfacing onto the playground site. Volunteers under age 18 (or under 19 in AL and NE) may not work on the
"playground construction site", as defined above. Volunteers under 18 but who rr>,~et this state's minimum age for employment may work on the side projects,
beautification and play enhancement projects, and other non-playground construction site projects and may help with preparation for the build day if they have
received written approval from a parent or legal guardian for participation. Any children. under state's minimum age for employment will not be supervised by
KaBOOM! in any way or be allowed to participate in playground or non-playground construction projects managed by KaBOOM!; however KaBOOM! will work
with the community partner to procure supplies for use by these children and to help Them plan projects that are occurring on a site that is distinctly separated
from the construction site. No children under this state's legal working age should be on the playground construction site.
1 understand that I will tie spendtng the day(s) as a volunteer for the Project and and fees, including, without limitation, court costs and at[omeys' fees, of any and
will be participating at my own risk. I acknowledge that my participation is every nature of character, inGuding, without limitation, for death, personal injury
voluntary and does not constitute a condition or requirement of employment. I and/or loss of property, whether anticipated or unanticipated, directly or indirectly,
further acknowledge that the Project will occur at a construction site and that the whether caused, in whole or in part, by the sole or concurrent negligence or
construction site will be a potentially dangerous place. I attest that I am physically wrongdoings, strict (lability or fault of the Released Parties or otherwise, arising
fit and prepared for this event. out of or connected in any way with my participation in the Project.
I will not create an unsafe situation for other individuals or myself nor will I use
any tool or engage in any task with which I am not completely comfortable. twill I acknowledge that I have read the foregoing paragraph and know and
abide by all applicable federal, state and local laws, as well as the rules and understand the full contents and effects of it. I understand the full nature, extent,
directions of the sponsors and coordinators. If I see any situation Thai i fee! is and import of Section 1542 of the California Civil Code and of the entire release
unsafe, I will Immediately call it to the attention of KaBOOM! or a safety stated in the foregoing paragraph. Accordingly, [waive and relinquish, any and
coordinator. If I bring any children or young adults with me to participate in the all rights or benefits that I may have under the provisions of Section 1542 of the
"roject, 1 will be solely responsible for providing for their safety and will keep them Califomia Civil Code, which reads as follows: 'A general release does not
der close supervision at all limes. FOR EACH PARTICIPANT UNDER 18, THE extend to claims which the creditor does not know or suspect to exist in its favor
rARENT OR GUARDIAN MUST FILL OUT A SEPARATE WAIVER. 1 ai the time of executing the release, which if known by him must have materially
understand that a volunteer may be at the Project to provide medical treatment in affected his settlement with the debtor.'
the event of an injury, and if necessary to assist in arranging transportation to I hereby grant KaBOOMI, the City of Cupertino, and the Rotary Cluti'of
medical facilities. CupeWn6full and complete permission to use project photographs, videography
On behalf of myself, as well as my heirs, executors, administrators and assigns, 1 and interview footage and quotations from me in legitimate promotions of the
hereby forever release, discharge, waive and agree to Indemnify and hold Project and to further the mission and vision of KaBOOMl. in any and all media
harmless KaBOOM!, the City of Cupertino; and the Rotary Club of Cupertino„ now known or hereinafter developed without restriction or compensation.
Playworld Systems Inc., and any additional sponsors of the Project, along with
their respective officers, directors, agents, employees, contractors, successors 1 understand that I have given up substantial rights by signing this Waiver
and assigns, and any volunteers to whom I give my consemf to provide medical and have signed k freely and voluntarily without any inducement,
treatment to me or to any chHdren or young adults under my supervision assurance or guarantee being made to me and 1 INTEND MY SIGNATURE
('Released Parties'), from and against any and all claims, demands, actions, TO BE A COMPLETE AND UNCONDITIONAL RELEASE of ail liability by
causes of action. obligations. liabilities. suits. losses, damages. costs. excenses. Released Parties to the greatest extent allowed by law.
I am here to volunteer from
Rotary Club of Cupertino (1 am a:
member)
_ Local Community
_ City of Cupertino
-staff member ! -non-staff
out a SEPARATE warner for your chilrL-use fhis section
Signature of Participant Date
Printed Name of Participant
Address
City State Zip
Email Address: Providing email allows us to send you photos of today's build!
^ 1 would not like to receive information about KaBOOM! in the future.
Signature of Parent or Legal Guardian of Participant
Printed Name of Parent or Legal Guardian
Do you affirm that your child or dependant meets this state's minimum
age requirements for employment?
^ Yes, my child may volunteer [:1 No, my child cannot volunteer
Printed Name of Child Participant Dat -