APPLICATION FOR SLEEPING WITH THE FISH PROGRAM
Friday evening – Saturday morning
August 05 – 06
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Participant/Child’s Last Name First Name MI Age
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Name of Sponsoring Organization/Youth Group
________________________ __________________________ ___________________
Parent/Guardian’s Last Name First Name Mother, Father, Other
____________________________ ______________________ ___________________
Home Address City CA, Zip Code
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Phone Number Alternate Phone Number
__________________________________________________
Email Address
I understand that there are risks and dangers inherent in participating in the above listed program. I also
understand that in order to be allowed to participate in the program, I must give up my rights to hold
Tafesilafa’i, Inc. and Aquarium of the Pacific liable for any injury or harm my child or participant may
suffer while participating in said program. Knowing this, and in consideration of being permitted to
participate in the program, I hereby voluntarily release Tafesilafa’i, Inc. and Aquarium of the Pacific from
any and all liability resulting from or arising out of my participation and my child’s participation in said
programs. I understand and agree that I am releasing not only the entities previously mentioned in this
paragraph, but also the officers, agents, and employees of those entities. I understand that this
Waiver/Release will have the effect of releasing, discharging, waiving and forever relinquishing any and all
actions or causes of action that I may have had, whether past, present, or future, to be negligent by a court
of competent jurisdiction. I understand and agree that this Waiver/Release applies to personal injury,
property damage, or wrongful death, which I may suffer, even if caused by the acts or omission of others. I
understand and agree that by signing this Waiver/Release, I am accepting full responsibility for any death
or personal injury or property damage suffered by me while in the above-mentioned program. I understand
and agree that this Waiver/Release will be binding on me, my spouse, my heirs, my personal
representatives, my assignees, my children and any guardian for said children. I understand and agree that
by signing this Waiver/Release, I am agreeing to release, indemnify and hold Tafesilafa’i, Inc. and
Aquarium of the Pacific, both of these entities’ officers, agents, or employees harmless from any and all
liability of costs, including attorney fees, associated with or arising from my participation or my child’s
participation in the above mentioned program at the Aquarium of the Pacific, hosted by Tafesilafa’i, Inc.
_____________________________________________ ___________________________________
Signature of Parent / Guardian Date
$7.00 Application Fee.
Please arrange payments with cashier's check, money order, or Pay Pal. Payment Type (circle one): Cash Pay Pal
Please make all checks payable to Tafesilafa’I, Inc. For more information, contact our office at (562)628-9282 Ext.107
655 Cedar Avenue, Long Beach, CA 90802-1222
www.tafesilafai.org