h beac c r e a l i Be t dockwe al cleanup day

a
as part of coast

p U n Clea h

Sat. Sept 21, 2013 8:00 am - 1:00pm

with transportation
Engaging Students in Contemporary Issues and Civic Action Through Art
Join us at Dockweiler Beach Tower 55 as we do our part to clean the oceanfront. Earn community service hours, meet new people, and feel great about helping the environment by keeping our beaches clean!

Transportation is available and lunch will be provided. https://51145.blackbaudhosting.com/51145/Action-Project

www.youthink.org
www.facebook.com/youthinkzimmer

For questions & to RSVP please contact: Carolina @ 323-761-8356; carolina@youthink.org youTHink is a program of the Zimmer Childrens Museum

Engaging Students in Contemporary Issues and Civic Action Through Art

youTHink Field Trip Permission Form I, _______________________, parent/ guardian of ___________________________ (student) hereby grant permission for our son/daughter to participate in the following event: Destination: Beach Clean-Up Dockweiler Beach Tower 55 12501 Vista Del Mar Playa del Rey, CA 90293

Date: Saturday, September 21st, 2013 Departure Time: 8:00 am Return Time: 1:00 pm Bus/Shuttle .

I understand that transportation will be by:

I understand that adequate and appropriate supervision will be provided. I recognize, however, that unanticipated situations and problems can arise on any trip, which situations or problems are not reasonably within the control of the supervising youTHink and/or Zimmer Childrens Museum staff (including volunteers). In such instances, I agree that the Zimmer Childrens Museum and the supervising youTHink and/or Zimmer Childrens Museum staff (including volunteers) are not to be held legally responsible in the event of accident or injury and I will hold the Zimmer Childrens Museum and the supervising youTHink and/or Zimmer Childrens Museum staff (including volunteers) harmless from any costs, liability, or expenses related thereto. I also give permission for emergency medical attention to be administered should that be necessary while on this fieldtrip. I also give my permission for photos of my child taken while participating in youTHink programs to be used in promotional materials for youTHink and the Zimmer Childrens Museum, which may include an institutional video, website, or brochures. Emergency Contact Information: During the fieldtrip, I can be reached at: If unable to contact parent/ guardian, in case of emergency, please call: (name, relationship and phone number) Parent/Guardian(s) Signature: Print Parent/Guardian(s) Name: Date: _______________ Home Phone Number: _____________

Address:_________________________________________ City, State, Zip: _________________________

A program of the Zimmer Childrens Museum 6505 Wilshire Boulevard #100 Los Angeles, CA 90048 Phone: (323) 761-8311 Fax: (323) 761-8990 www.youthink.org

Engaging Students in Contemporary Issues and Civic Action Through Art

Formulario de permiso de paseo de youTHink Yo/Nosotros ________________________ los padres/guardianes de, una/un menor, comprendemos el tipo de viaje planeado a: Destino: Beach Clean-Up Dockweiler Beach Tower 55 12501 Vista Del Mar Playa del Rey, CA 90293 Sabado, 21 de Septiembre del 2013 8:00 am Hora de Retorno: __1:00 pm Autobus/Camion ,

Fecha:

Hora de Salida:

Entendemos que el transporte sera a traves de:

Entendemos que la supervisin adecuada y apropiada se proporcionar. Reconocemos, sin embargo, que situaciones y problemas imprevistos pueden surgir en cualquier viaje, problemas no razonablemente bajo el control del supervisor de youTHink/o Zimmer Childrens Museum (incluyendo voluntarios). En tales casos, nosotros concordamos que ni el Zimmer Childrens Museum ni el supervisante/s o voluntario/s de youTHink y/o Zimmer Childrens Museum debern ser tenidos legalmente responsable. En caso de accidente o herida, mantendremos al Zimmer Childrens Museum y todo personal de youTHink y/o el Zimmer Childrens Museum (incluyendo voluntarios) inocuo de cualquier costo, obligacin, o gastos relacionados a este. Yo/Nosotros otorgamos permiso de la administracin de cualquier atencin mdica en caso de una emergencia durante este paseo. Yo/Nosotros tambin otorgamos permiso de utilizar fotografas tomadas durante este paseo para publicaciones y materiales promocinales de youTHink y el Zimmer Childrens Museum, al igual que videos institucionales, pagina de Internet folletos, y ocasionalmente, peridicos. Durante el paseo, podr ser contactada/o al: padres/guardianes, en caso de emergencia, favor de llamar al relacionada esta persona? To? Ta? Abuela? Etc.) Si incapaz de contactar a _____(como esta

Firma de padre(s)/guardin(es): ____________________________ Fecha: ____________________ Nombre de padre(s)/guardin(es): _____________________ Numero telefnico: ____________________ Domicilio___________________________ Ciudad, Estado, Cdigo Postal: ___________________________

6505 Wilshire Boulevard #100 Los Angeles, CA 90048 Phone: (323) 761-8987 Fax: (323) 761-8990 www.youthink.org

COASTAL CLEANUP DAY 2013 WAIVER OF LIABILITY AND EXPRESS ASSUMPTION OF RISK
(PLEASE READ CAREFULLY)
I agree as follows: 1. I am volunteering my services for Coastal Cleanup Day 2013 (the Event); 2. I will perform assigned tasks that are within my physical capability, and I will not undertake tasks that are beyond my ability; 3. I will not participate if under the influence of alcohol or any drug that could impair my physical or mental abilities; 4. I am familiar with the safe operation and use of machinery, equipment and tools that I may utilize in connection with the Event, and I will not undertake to use any machinery, equipment or tools with which I am unfamiliar or which I do not know how to operate safely; 5. I have received appropriate instruction regarding this Event, including appropriate safety and emergency procedures, I fully understand those instructions, and I agree, after proper inspection, to use only the supplies, tools and equipment provided by Event organizers; 6. I will perform only those tasks assigned, observe all safety rules, and use care in the performance of my assignments; 7. I specifically acknowledge that I am engaging in this activity as a volunteer and not as a State of California employee, agent, official, officer or representative, and further acknowledge that I am not entitled to any compensation, benefit or insurance coverage from the State of California, the Department of Parks and Recreation, the California Coastal Commission, the California State Parks Foundation, or any Event promoter, sponsor, or organizer, nor will I make any such claim. I understand and agree that neither the State of California, California Coastal Commission, California State Parks Foundation, California Department of Parks & Recreation, California Department of Fish & Wildlife, California State Parks, California State Parks Department - Division of Boating & Waterways, California Department of Transportation, CALTRANS, City of Long Beach El Dorado Nature Center, County of Orange/OC Parks Volunteer Services, Trails4All, Ventura County Coalition for Coastal & Inland Waterways, Heal the Bay, City of Santa Monica, Union Bank, Anheuser-Busch, Kaiser Permanente, Mattel, Safeway, LADWP, LA Waterkeeper, Malibu Surfing Association, Friends of Ballona Wetland, Ballona Creek Restoration, Santa Monica Bay Restoration Foundation, City of Hermosa, City of Culver, City of Downey, City of Torrance, City of Redondo, City of Malibu, Malibu Foundation for Environmental Education, Cabrillo Marine Aquarium, City of Agoura Hills, Greater Los Angeles Council of Divers, Eco Diver Center, Nora Sterry Elementary, City of Palos Verdes Estates, Malibu Divers, Surfrider Foundation, California Wildlife Center, Office of Senate Disctrict 20, Conejo Valley YMCA, Ken Malloy Harbor Regional Park, Chase Bank, Caf Tropical, Toyota, Vons, The Arbor Collective, Bristol Farms, The Cheesecake Factory, Chipotle, The Counter, Marina Harbor Anchorage, Pacific Mariner's Yacht Club, Ralphs, Pro SUP Shop, REI, UCLA Marina Aquatic Center, Poseidon (SUP), Rustys, KROQ, SEA Lab, Roundhouse Aquarium, Black Surfers Collective, California Historical Society, California Department of Fish & Game, County of Los Angeles Department of Beaches and Harbors, County of Los Angeles Department of Public Works, City of Los Angeles Bureau of Sanitation, City of Los Angeles Department of Recreation & Parks, City of Los Angeles, Los Angeles City Council District 6, Los Angeles Conservation Corps, U.S. Army Corp of Engineers, American Honda, Arroyo Seco Foundation, Ballona Creek Renaissance, Crystal Geyser, The Crystal Casino and Hotel, Culver City Bike Coalition, Dive N Surf, Gruen Associates, Harbor City Neighborhood Council, Honda of Torrance, Ken Malloy Harbor Regional Park, Kiwanis Los Angeles and Kiwanis International, K.M.H.R.P. Advisory Board, KTLA, Local Restaurant, Los Angeles Unified School District, Naam Yoga LA, The Neighborhood Church, The Pacific American Volunteer Association, Santa Monica Pier Aquarium, Wisdom Academy, Boy Scouts of America, Adventure Voyaging, Cub Scouts of America, Girl Scouts of America, St. Raphael Elementary School, Port Royal Yacht Club, Friends of the L.A. River, Surfbus, Channel Islands Scuba Dive Team, Channel Islands Scuba, nor any of their respective employees, officers, agents or assigns, (collectively referred to as Released Parties), may be held liable or responsible in any way for any injury, death or other damages to me or my family, heirs, or assigns that may occur as a result of my participation in the Event, or as a result of product liability or the negligence, whether passive or active, of any party, including Released Parties, in connection with the Event. I understand that cleaning up beaches or inland water areas involves certain inherent risks, including but not limited to, the risks of possible injury, infection or loss of life as a result of contact with needles, condoms, metal objects, burning embers or other hazardous materials, wild animals, poisonous plants, snakes, or from over-exertion or environmental conditions, including but not limited to flooding, rockslides, sun exposure, or dangerous terrain. Despite the risks, I still choose to participate in such activity. No known physical or health limitation prevents me from safely participating in this Event. In Consideration for being allowed to participate, I personally assume all risks, whether foreseen or unforeseen, in connection with the Event of any harm, injury or damage that may befall me as a participant. If I am injured during the Event, I authorize any physician licensed in California to perform such emergency treatment as he or she believes, in his or her sole judgment, may be necessary. I am over the age of eighteen and legally competent to sign this liability release, or I have acquired the written consent of my parent or guardian. I understand that the terms herein are contractual and not a mere recital, this instrument is legally binding, and I have signed this document of my own free act. I agree to allow my image to be used in published materials and web sites that promote the programs of the California Coastal Commission. By including my email address below, I understand that the California Coastal Commission may contact me about future Coastal Cleanup Day events and other Public Education programs. I HEREBY RELEASE AND HOLD HARMLESS THE RELEASED PARTIES FROM ANY CLAIM OR LAWSUIT FOR PERSONAL INJURY, PROPERTY DAMAGE, OR WRONGFUL DEATH, BY ME, MY FAMILY, ESTATE, HEIRS, OR ASSIGNS, ARISING OUT OF PARTICIPATION IN THE EVENT, INCLUDING BOTH CLAIMS ARISING DURING THE ACTIVITY AND AFTER I COMPLETE THE ACTIVITY, AND INCLUDING CLAIMS BASED ON NEGLIGENCE OF OTHER PARTICIPANTS OR THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE. I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS LIABILITY RELEASE AND ASSUMPTION OF RISK. ___________________________________ Spelling of Participants Name ___________________________________ Signature of Participant ____________ Date ______________________________ Address ______________________________ Address _______________________________ Phone _______ E-mail

IF PARTICIPANT IS UNDER 18, THE PARENT (OR GUARDIAN, IF ANY) MUST SIGN. I am the parent or legal guardian of the above participant and he/she has my permission to participate in Coastal Cleanup Day. I have read and agree to the provisions stated above for myself and the participant. Further, I understand and agree that the sponsors and organizers of the Event are not responsible for supervision of minor participants and that if I allow the above minor to participate without my supervision, I assume all the risks from such participation. ___________________________________ Signature of Parent or Legal Guardian ___________ Date _______________________________ Phone ______________________________ _______________________________ Address E-mail ______________________________

DA DE LIMPIEZA DE COSTAS 2013 EXENCIN DE RESPONSABILIDAD Y ASUNCIN EXPRESA DEL RIESGO (POR FAVOR LEER ATENTAMENTE)
Confirmo mi consentimiento a lo siguiente: 1. Mis servicios en el Da de Limpieza de Costas 2013 (el Evento) son voluntarios. 2. Realizar aquellas tareas que se me asignen y que no excedan mis capacidades fsicas, y no realizar tareas que excedan mis facultades. 3. No participar en el Evento si me encuentro bajo la influencia del alcohol o de cualquier droga que pueda menoscabar mis capacidades fsicas o mentales. 4. Estoy familiarizado con el uso y el manejo seguro de la maquinaria, los equipos y las herramientas que pueda utilizar en relacin con el Evento, y no utilizar ninguna maquinaria, equipamiento o herramientas que desconozca o que no sepa manejar con seguridad. 5. He recibido formacin adecuada en lo referente a este Evento, incluidos procedimientos adecuados de seguridad y de emergencia, entiendo por completo dichas instrucciones, y estoy de acuerdo, tras una inspeccin adecuada, en utilizar nicamente los suministros, herramientas y equipos proporcionados por la organizacin del Evento. 6. Slo llevar a cabo las tareas que se me encomienden, seguir todas las normas de seguridad, y prestar la mxima atencin durante la realizacin de mis tareas. 7. Acepto especficamente que estoy tomando parte en esta actividad como voluntario y no como empleado, agente, funcionario o representante del Estado de California, as como acepto que no tengo derecho a recibir compensacin o ganancia alguna o a que me cubra ningn seguro del Estado de California, del Departamento de Parques y Ocio, de la Comisin Costera de California, de la Fundacin de Parques del Estado de California, o de cualquier promotor u organizador del Evento, ni realizar ninguna reclamacin al respecto. Comprendo y acepto que ni el State of California, California Coastal Commission, California State Parks Foundation, California Department of Parks & Recreation, California Department of Fish & Wildlife, California State Parks, California State Parks Department - Division of Boating & Waterways, California Department of Transportation, CALTRANS, City of Long Beach El Dorado Nature Center, County of Orange/OC Parks Volunteer Services, Trails4All, Ventura County Coalition for Coastal & Inland Waterways, Heal the Bay, City of Santa Monica, Union Bank, Anheuser-Busch, Kaiser Permanente, Mattel, Safeway, LADWP, LA Waterkeeper, Malibu Surfing Association, Friends of Ballona Wetland, Ballona Creek Restoration, Santa Monica Bay Restoration Foundation, City of Hermosa, City of Culver, City of Downey, City of Torrance, City of Redondo, City of Malibu, Malibu Foundation for Environmental Education, Cabrillo Marine Aquarium, City of Agoura Hills, Greater Los Angeles Council of Divers, Eco Diver Center, Nora Sterry Elementary, City of Palos Verdes Estates, Malibu Divers, Surfrider Foundation, California Wildlife Center, Office of Senate Disctrict 20, Conejo Valley YMCA, Ken Malloy Harbor Regional Park, Chase Bank, Caf Tropical, Toyota, Vons, The Arbor Collective, Bristol Farms, The Cheesecake Factory, Chipotle, The Counter, Marina Harbor Anchorage, Pacific Mariner's Yacht Club, Ralphs, Pro SUP Shop, REI, UCLA Marina Aquatic Center, Poseidon (SUP), Rustys, KROQ, SEA Lab, Roundhouse Aquarium, Black Surfers Collective, California Historical Society, California Department of Fish & Game, County of Los Angeles Department of Beaches and Harbors, County of Los Angeles Department of Public Works, City of Los Angeles Bureau of Sanitation, City of Los Angeles Department of Recreation & Parks, City of Los Angeles, Los Angeles City Council District 6, Los Angeles Conservation Corps, U.S. Army Corp of Engineers, American Honda, Arroyo Seco Foundation, Ballona Creek Renaissance, Crystal Geyser, The Crystal Casino and Hotel, Culver City Bike Coalition, Dive N Surf, Gruen Associates, Harbor City Neighborhood Council, Honda of Torrance, Ken Malloy Harbor Regional Park, Kiwanis Los Angeles and Kiwanis International, K.M.H.R.P. Advisory Board, KTLA, Local Restaurant, Los Angeles Unified School District, Naam Yoga LA, The Neighborhood Church, The Pacific American Volunteer Association, Santa Monica Pier Aquarium, Wisdom Academy, Boy Scouts of America, Adventure Voyaging, Cub Scouts of America, Girl Scouts of America, St. Raphael Elementary School, Port Royal Yacht Club, Friends of the L.A. River, Surfbus, Channel Islands Scuba Dive Team, Channel Islands Scuba, ni ninguno de sus respectivos empleados, funcionarios, agentes o encargados, (a los que nos referiremos de manera colectiva como a la Partes Relacionadas), puede ser considerado responsable en modo alguno por cualquier herida, muerte u otros daos y perjuicios que yo, mi familia, mis herederos o mis allegados podamos sufrir como resultado de mi participacin en el Evento o como resultado de la responsabilidad por productos defectuosos o la negligencia, ya sea pasiva o activa, de cualquier parte, incluidas la Partes Relacionadas, relacionada con el Evento. Yo comprendo que la limpieza de playas, ros o arroyos implica ciertos riesgos inherentes tales como pero no limitados al riesgo de sufrir heridas, infecciones o perder la vida como resultado del contacto con agujas, condones, objetos metlicos, brasas incandescentes o materiales peligrosos, animales salvajes, plantas venenosas, serpientes; o a causa del sobreesfuerzo o las condiciones ambientales tales como pero no limitadas a inundaciones, desprendimiento de rocas, exposicin al sol o terrenos peligrosos. A pesar del riesgo, todava quiero participar en la actividad. Ninguna limitacin fsica o sanitaria me impide participar con seguridad en el Evento. En caso de que se me permita participar, yo asumo personalmente todo el riesgo, tanto previsto como imprevisto, de sufrir cualquier lesin, herida o dao relacionado con el Evento que pudiera ocurrirme como participante. Si resultase herido durante el Evento, autorizo a cualquier mdico inscrito para ejercer en California a realizar el tratamiento de emergencia necesario que l/ella juzgue conveniente. Tengo ms de dieciocho aos y competencia legal para firmar esta exencin de responsabilidad, o he obtenido el consentimiento escrito de mi padre/madre o tutor legal. Yo asumo que las clusulas contenidas en este documento son contractuales y no meramente declarativas, y que es un instrumento que me vincula jurdicamente, y lo he firmado por propia voluntad. Yo estoy de acuerdo con permitir que mi imagen sea usada en materiales impresos y en sitios en el Internet que promuevan los programas de la Comisin Costera de California. Al incluir my correo electrnico en este documento, acepto que la Comisin Costera de California pueda contactarme en un futuro acerca de eventos relaciones con el Da de La Limpieza de la Costa u otros programas relacionados con educacin pblica. Por la presente descargo y eximo de responsabilidad a las Partes Relacionadas por cualquier demanda o pleito judicial por causa de lesiones corporales, daos a la propiedad o muerte por negligencia, que podamos sufrir yo, mi familia, mi propiedad, mis herederos o mis allegados, y que se deba a la participacin en el Evento, incluyendo tanto las demandas que surjan durante la actividad como despus de que yo haya concluido la actividad, e incluye las demandas basadas en la negligencia de otros participantes o de las Partes Relacionadas, ya sea negligencia activa o pasiva. ME HE INFORMADO POR COMPLETO DEL CONTENIDO DE ESTA EXSENCIN DE RESPONSABILIDAD Y ASUNCIN DEL RIESGO. ___________________________________ Nombre del participante deletreado ___________________________________ Firma del participante ____________ Fecha ______________________________ Direccin _______________________________ Telfono _______

______________________________ Direccin Correo electrnico

SI EL PARTICIPANTE TIENE MENOS DE 18 AOS, EL PADRE/MADRE (O TUTOR LEGAL, SI LO HUBIESE) TIENE QUE FIRMAR. Soy el padre/madre o tutor legal del participante inscrito arriba y l/ella tiene mi permiso para participar en el Da de Limpieza de Costas. He ledo y estoy de acuerdo con las clusulas detalladas arriba en mi nombre y en nombre del participante. Adems, entiendo y estoy de acuerdo con que los patrocinadores y organizadores del Evento no son responsables de supervisar a los participantes menores de edad y que si permito al menor inscrito arriba a participar sin mi supervisin, yo asumo todos los riesgos que dicha participacin conlleva. ___________________________________ Firma del progenitor o tutor legal ___________ Fecha ______________________________ ______________________________ Direccin _______________________________ Telfono _______________________________ Correo electrnico