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2. 

4. Experience a delightful summer evening at Purissia Park for an outdoor dinner and movie experience. Before the film begins, create a cozy spot at the park before heading over to grab a bite from a local food truck. Additionally, indulge in some sweet treats from Mister Softee. As the sun sets, enjoy a cinematic experience featuring a beloved film on a massive outdoor screen. Throughout the event, members of the Youth Commission will be hosting a coffee and hot cocoa bar, along with serving guests delectable popcorn. Ensure you bring your own chair and blanket to enhance your movie night experience!

6. First Name
7. Last Name
9. # of People in Party*
11. Email*
13. How did you hear about this event?

    1. Activity Guide
    2. Town Website
    3. Social Media
    4. Flyer
    5. Personal Invitation
    6. Other
14. Resident of Los Altos Hills*

    1. Yes
    2. No
15. Do you plan to purchase food?*

    1. Yes
    2. No
17. Release of Liability & Assumption of Risk Agreement

    In consideration of the acceptance of the application for entry into the classes or activities listed, I hereby waive, release and discharge any and all claims for damages for death, personal injury, or property damage which I may have, or which may hereafter accrue to me as a result of my participation in said classes or activities.

    I am aware that these classes or activities subject me to physical risks and dangers, nevertheless, I voluntarily agree to assume any and all risks of injury or death, and to release, discharge, and hold harmless all of the entities or persons mentioned above who, through negligence or carelessness, might otherwise be liable to me, or my heirs, personal representatives, next of kin, spouse or assigns.  It is understood and agreed that this waiver, release, and assumption of risk is to be binding on my heirs, personal representatives, next of kin, spouse and assigns. 

    I have fully read this Agreement and fully understand its content.  Furthermore, the significance of this release of liability and assumption of risk agreement has been EXPLAINED TO THE MINOR.

    In addition, should the Town of Los Altos Hills and/or its representatives take photographs of my or my child’s program, event or activity, I agree to allow the use of my and or my child’s photograph for program publicity purposes only.

19. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature.

    1. I agree.
21. Electronic Signature
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field