Clone of Parents' Respite Retreat Registration September 26-28, 2025

Parent 1 Name

First NameLast Name

Parent 1 Gender

Parent 1 Sexual Orientation

Parent 1 Race

Parent 1 Hispanic Ethnicity

Parent 1 Primary Language

Parent 1 DOB

Date

Parent 1 Age

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Parent 2 Name

First NameLast Name

Parent 2 Gender

Parent 2 Sexual Orientation

Parent 2 Race

Parent 2 Hispanic Ethnicity

Parent 2 Primary Language

Parent 2 DOB

Date

Parent 2 Age

Parent 2 Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Parent 2 Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

We would like to contact you via SMS (text) to provide, updates, reminders and about other community events. Please check which one you consent to. You can withdraw at anytime.

Medical conditions/allergies CAFA needs to be aware of:

Is this your first respite event with CAFA?

How many children do you have?

Will anyone be needing vegetarian meals?

While we will have a variety of delicious food available, we want to inform you that we cannot guarantee gluten-free options at this event. If you have specific dietary restrictions or concerns related to gluten, we recommend bringing any necessary food items with you or making alternative arrangements.

Please indicate which meals you'll be joining us for (this will help with reducing our cost and food waste)

Special Accommodations? i.e. ADA.

Do you currently live in or adopted through Sacramento county?

I understand that I need to notify CAFA 14 days prior to the event if there are any changes to attending the event.

*** Enrollment Form Parental/Guardian Consent, Release and Waiver of Liability and Indemnity Agreement WAIVER AND RELEASE: In consideration of my/my minor child(ren)’s enrollment and being permitted to participate in any way in CAFA activities, I name of adult participant(s) for myself, my heirs, personal representatives or assigns, and on behalf of the minor participant(s) identified below, do hereby release, waive, discharge, and covenant not to sue CAFA and its officers, employees, agents, volunteers and funders, including the County of Sacramento and its employees and agents, from liability from any and all claims including the negligence of CAFA and its officers, employees, agents, volunteers and funders, including the COUNTY, its governing Board, officers, directors, officials, employees, and authorized volunteers and agents, resulting in personal injury, accidents or illnesses including death, and personal property loss arising from, but not limited to, participation in CAFA activities. INDEMNIFICATION AND HOLD HARMLESS: I agree to indemnify and hold harmless CAFA and its officers, employees, agents, volunteers and funders, including the COUNTY, its governing Board, officers, directors, officials, employees, and authorized volunteers and agents, from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees, brought as a result of my involvement in CAFA activities, and to reimburse them for any such expenses incurred. SEVERABILITY: I expressly agree that the foregoing waiver of liability, assumption of risk and indemnity agreement is intended to be as broad and inclusive as is permitted by the laws of the State of California and that if any portion thereof is held to be invalid, the enforceability of the remaining Provisions shall not be affected. ACKNOWLEDGMENT OF UNDERSTANDING: I have read this waiver of liability and indemnity agreement, and fully understand its terms and that I am giving up substantial rights, including my right to sue. I understand that this document relieves CAFA and its funders including the County of Sacramento and others from liability for negligence resulting in property damage, personal injury, emotional, disability, and death. I acknowledge and agree that I am signing this agreement freely and voluntarily, and intend by my signature for this to be a complete and unconditional release of liability to the greatest extent allowed by law.

Please choose:

(VOLUNTARY/OPTIONAL) I further understand and agree that:
• Photographs, pictures, slides, movies, voice, or videos may be taken in connection with participation in the activity without compensation from CAFA or the County of Sacramento, and I consent to the use of photographs, pictures, voice, names, slides, movies, or videos for any legal purpose.

Please select:

NAME OF PERSON FILLING OUT THIS FORM

First NameLast Name

I agree, consent and acknowledge to all of the above:

Parents' Respite Retreat 2026

Required Deposit