Family Enrollment Form

To enroll your child in the next session of the Healthy Kids Program, please complete and submit the registration form below. You will receive a confirmation by email. If you have any questions about the program, please call 928-336-7958.

Program Waiver

I, the undersigned hereby release Yuma Regional Medical Center (YRMC); it’s instructors, leaders, supervisors, staff & volunteers of any liability that may incur while participating in the Healthy Kids program.  I further understand that participating in physical activity and consuming foods may cause harm or personal injury.  I personally assume all foregoing risks and accept personal responsibility for any and all claims and/or causes of actions following any such personal injury.  In the case of personal injury and/or harm, I will seek medical attention from my personal physician. 

YRMC reserves the right to photograph facilities, activities and program participants for potential future use.  All photos will remain the property of the YRMC and may be used for publicity or promotion purposes.
Program Waiver:*

Photo Release

For the consideration stated herein, I hereby assign and grant for Yuma Regional Medical Center (YRMC), their clients, customers, agents, licensees and assigns, free and unlimited right and permission to copyright and/or publish photographic portraits or pictures of me in which I may be included in whole or in part or composite or reproductions thereof in color or otherwise made through any media at their studios or elsewhere for art, advertising, trade or similar lawful purpose whatsoever.

I hereby waive my right to inspect and/or approve the finished product or the advertising copy that may be used in connection therewith.

I hereby release and discharge YRMC, its successors and all persons under its permission or authority or those for whom it is acting from any liability by virtue of any blurring, distortion, alteration, optical illusion or use in composite form that may occur or be produced in the taking of said picture or in any processing tending toward the completion of the finished product.
Photo Release:*

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