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2. You do not need to sign in to complete this form
4. PLEASE NOTE
   All transfer requests require 5 business days notice prior to the start of the activity in order to be considered for a transfer to another activity.
6. I need to transfer*

   1. Myself
   2. Family Member
8. Your First Name*
9. Your Last Name*
11. Participant's Full Name
    (if different from above)
12. Your Email or Phone #*
14. Activity Name Currently Enrolled In*
15. Activity #
    (List day and time if number unknown)
17. Transfer participant to:*
19. Additional Transfer Information
21. Reason For Transfer*

    1. Schedule Conflict
    2. Medical / Illness
    3. Family Emergency

    1. COVID-19
    2. Other
23. Reason for transfer (Other)
25. Photo/Video Release: I agree to allow the use of my photograph or my child's photography for program publicity. If you would like to opt-out of the photo release please go to www.cityofcampbell.com/recreation and fill out the online form. Medical Release: Pursuant to provisions of sec. 6910 et seq of the California Family Code, and other applicable laws, I hereby authorize the City of Campbell Recreation & Community Services Department to procure, & consent to, medical, hospital or dental care for myself or my child in the event of injury as a result of participation in this program. Waiver & Release of Liability: In consideration of my participation, I hereby release, discharge and covenant not-to sue the City of Campbell & Campbell Redevelopment Agency, their officers, employees & volunteers, from any & all present & future claims, demands, actions, or causes of action resulting from any accidents, injuries, deaths, or loss of and/or damage to my/our person(s) or property arising out of or connected with my/our participation in the above activity (ies) (except for claims legally caused by the sole negligence or willful misconduct of the City or others listed above). I hereby voluntarily waive any & all claims resulting from ordinary negligence, present & future, that may be made by me, my family, estate, heirs, or assigns. Further, I am aware that this activity may involve certain risks or possible dangers, including death, & that equipment provided for my protection may be inadequate to prevent serious injury. I am voluntarily participating in this activity with knowledge of the danger involved and hereby agree to accept any & all inherent risks of property damage, personal injury, or death. I further agree to indemnify & hold harmless the City of Campbell & others listed above for any & all claims arising as a result of my engaging in this activity. I understand that this waiver will continue in full legal force & effect. I further agree the venue for any legal proceedings shall be in California. I affirm I am of legal age & am freely signing this document. I have read this form & fully understand that by signing this form, I am giving up legal rights and/or remedies which shall be available to me against the City of Campbell or any of the parties listed above. The City is not responsible for lost or stolen articles. Refunds, less a $10.00 admin. fee, will be given to registered participants who cancel up to 5 business days in advance of a class start date. Cancellations less than 5 business days’ notice will not receive a refund.
27. Liability Release*

    1. By checking the button you acknowledge that you have read and agree to the liability release listed above.
29. This a request only
    Staff will respond within 48-72 hours of this submission with a response to your request.
30. REQUIRED
    5 business days notice is required for any transfers to be considered.
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32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit Submit and Print

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