BCYF
James Michael Curley Recreation Center
1663 Columbia Road
South Boston, MA 02127

CURLEY COMMUNITY CENTER
2014
WAIVER

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Name:______________________________________________________________

Parent/Guardian
Name:______________________________________________________________

Home Address:______________________________________________________

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Phone Number (area code):___________________________________________

Emergency Contact:_________________________________________________

I HEREBY, FOR MYSELF, MY HEIRS, EXECUTORS AND ADMINISTRATORS, WAIVE AND RELEASE AND HOLD HARMLESS THE CURLEY COMMUNITY CENTER FOR YOUTH & FAMILIES, THE L STREET SWIMMING CLUB, INC., THE BROWNIES' DIRECTORS AND STAFF MEMBERS AGAINST ANY AND ALL RIGHTS, AND CLAIMS FOR DAMAGES AND/OR INJURIES SUFFERED DURING PARTICIPATION IN ANY AND ALL ACTIVITIES AT THE JAMES MICHAEL CURLEY COMMUNITY CENTER.

Signature:__________________________________________________________

BOSTON CENTERS FOR YOUTH & FAMILIES
THOMAS M. MENINO, MAYOR
DAPHNE GRIFFIN, EXECUTIVE DIRECTOR
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