Boardwalk Beach Blitz

Boardwalk Beach Blitz

Friday, September 13 - Saturday, September 14, 2019

Authorization Form

Submit this form for each participant before the event. Thank you!


Participant Information

(Found on confirmation email sent during registration.)

Main Contact

Participant Name*
Age Category*

Emergency Contact Information

Main Contact

Alternate Contact


Authorization to Allow Event Supervisor to Consent to Minor's Medical Care*

I, the undersigned, am a parent or legal guardian authorized to give consent for medical and dental care of the participant identified above, a minor who is a participant in the above-mentioned event. I hereby authorize the event Supervisor or his/her adult designee, who are adults into whose care the minor has been entrusted, to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care to be rendered to the minor under the general or special supervision and upon the advice of a physician and surgeon licensed under the provisions of the Medical Practice Act, or to consent to an x-ray examination, anesthetic, dental or surgical diagnosis or treatment, and hospital care to be rendered to the minor by a dentist licensed under the provisions of the Dental Practice Act.

This authorization is given in advance of any specific diagnosis or treatment being required to provide authority to consent to and render care when a physician or dentist may deem it advisable, and pursuant to the provisions of section 6910 of the Family Code of California that states: "The parent or guardian of a minor may authorize in writing an adult into whose care a minor has been entrusted to consent to medical care or dental care, or both for the minor."

If I am a caregiver authorized to give consent for medical or dental care, but I am not the minor’s parent or legal guardian, I understand that I must provide to Santa Cruz Seaside Company a completed CAREGIVER’S AUTHORIZATION AFFIDAVIT before the minor can participate in the event.


Photos Release*

Unless marked here to the contrary, we permit the use of any photos taken during the overnight activities for publicity, promotional or other commercial purposes.


Indemnification/Hold Harmless

The participant and his/her parent(s) and/or guardian(s) agrees to defend, indemnify and hold harmless Santa Cruz Seaside Company and its affiliated companies and the City of Santa Cruz from and against all claims, losses, judgments, demands and expenses (including attorney's fees) arising out of or in connection with the participant’s attendance at this event, except to the extent that such claims result from the sole negligence of Santa Cruz Seaside Company and its affiliated companies. This indemnification includes, without limitation, claims resulting from: loss of, or damage to property and/or bodily injury, personal injury and/or loss of life.


Agreement to Terms

I hereby agree to the terms of participation specified above. I also have read and agree to the terms and policies listed in the event Planning Guide.

All information provided by me on this form is correct.*
Use your mouse or finger to draw your signature above.

Parent / Guardian

Address