Safety Waiver for the "Breaking the Silence" Mixer

Pacific Autism Center of Education
Youth Leadership Committee Presents:

“Breaking the Silence” Benefit Mixer

March 20th, 2010
7:00 p.m. – 10:30 p.m.
High School Students only

San Jose City College
2100 Moorpark Avenue,
San José, CA 95128-2799

Hello Parents/Guardians and High School Students,

If you are on this page, then you have received a guest pass for the "Breaking the Silence" Mixer on March 20th, 2010 from 7:00 - 10:30 p.m. at San Jose City College Main Gym. To complete the guest pass, read the following information below and understand the terms and conditions regarding the Liability Release, Medical Release, and the Mixer Guidelines.

Liability Release:

The attendee agrees to release Pacific Autism Center for Education and the San Jose City College from any and all liability for any injury or damage, arising out of or in any way connected with participation in the mixer. The attendee agrees to release and hold harmless Pacific Autism Center for Education and the San Jose City College, including but not limited to their staff members, agents, security officers, and facilities used by both entities from any cause of action, claims, or demands now and in the future. Pacific Autism Center for Education and the San Jose City College will not be held liable for any actions, including but not limited to personal injury and/or personal property damage, which may occur on the premises before, during, or after the mixer.

Therefore, the attendee agrees to release Pacific Autism Center for Education and the San Jose City College from any and all liability, claims and actions that may arise from injury or harm in connection with this mixer. The attendee understands that this release covers liability, claims and actions caused entirely or in part by acts or failures to act by the Pacific Autism Center for Education staff and the San Jose City College staff, including but not limited to negligence, mistake, or failure to supervise. The attendee recognizes that this release means that he/she is giving up rights to sue Pacific Autism Center for Education and the San Jose City College for any injuries, damages, or losses he/she may incur while participating in this mixer.

Furthermore, the attendee agrees to obey the mixer guidelines and take full responsibility of his/her behavior in addition to any damage he/she may cause to the San Jose City College’s facilities; therefore, the attendee agrees to indemnify Pacific Autism Center for Education and the San Jose City College.

After reading the following waiver, a parent or guardian (if attendee under 18) hereby grants the permission necessary to allow his/her child to attend the mixer. The parent or guardian also further agrees to release and hold harmless Pacific Autism Center for Education and the San Jose City College from any and all liability whether caused by negligence or otherwise, for any claim, judgment, loss, liability, cost and expenses (including but without limitations, legal fees and costs) arising out of or connected with the mixer.

By agreeing to this release form, the attendee therefore agrees to assume and take upon himself/herself all the risks and responsibilities in any way associated with this mixer.

The attendee and parent/guardian have read the entire waiver. Fully understanding it, both the attendee and parent/guardian voluntarily agree to be legally bound to it.

Medical Release:

The parent or guardian (if attendee under 18) acknowledges the fact that the attendee’s participation in the mixer subjects himself/herself to personal injury. Despite precautions, accidents and injuries may occur. For this reason, the parent or guardian must provide Emergency Contact information below. In the event that the attendee sustains an injury or illness during the mixer, the parent or guardian hereby authorizes Emergency Medical Technicians provided by Pacific Autism Center for Education to obtain necessary medical treatment for the attendee. In doing so, the parent or guardian agrees to release and hold harmless Pacific Autism Center for Education and the San Jose City College in the exercises of this authority.

Please fill out the emergency contact information on the guest passes.

Guidelines:

The Youth Leadership Committee presents the benefit mixer, “Breaking the Silence,” which is open to the South Bay Area high school teens. All high school students must bring a high school ID along with their ticket to the mixer. Pacific Autism Center for Education and the San Jose City College have the right to refuse anyone at the door. Students will be admitted into the dance between 6:45 p.m. – 8:00 p.m. Students arriving after this time will not be allowed into the dance. Once students are inside the dance, they are not allowed to leave prior to the end of the dance. There are no in & out privileges.


All San Jose City College and school rules will remain in effect. This includes the dress code. Please make sure to dress in appropriate attire. The dancing at the mixer must comply with school rules. Illegal activity occurring within the premises of the San Jose City College is prohibited. Illegal substances and flammable items are forbidden. Any such items will be checked for and then confiscated by security prior to entering the mixer. Also, keep in mind that Pacific Autism Center for Education and the San Jose City College are not responsible for any lost valuables brought to the dance. Additionally, parents or guardians (if attendee under 18) must pick up their children promptly at 10:30 p.m. once the mixer ends.

If you have any questions, comments, or concerns please contact pacemixer@gmail.com