Karma Club Registration and Waiver

Registration Form – ENGLISH

Parent Information


Student Information


Emergency Contact Information


Age Verification


I, parent/guardian, testify that my child/student is 13 years old or older and has my permission to attend Karma Club Teen, a teen space for 13-19 year olds in Marin County, located at Northgate Mall. There is no formal check-in/check-out process, as kids can drop in and leave as they please at no cost. We are a nonprofit funded by grants and donations.

Eligibility Requirements:

To participate in Karma Club and our programs, you must meet the following requirements:

* Be in at least 8th grade

* Be between the ages of 13 and 19

* Be a resident of Marin County

KARMA CLUB WAIVER AND RELEASE OF LIABILITY


Karma Club is a safe space built on respect and kindness. There is no bullying, name-calling, harassment, or discrimination of any sort. No using or bringing illegal substances (smoking, drugs, or alcohol) in the center. No kissing, touching, or public display of attention. We do not have space to store bikes, so students must lock their bikes outside of the center. Students are responsible for their own belongings and should not leave personal items unattended. Students are allowed to take one free drink and one free snack each time. Students are responsible for cleaning up after themselves whenever they finish a snack, game, or art project. Liquids must be drained into the bottom sink of the bathroom (not dumped in the water fountain) before being thrown into the trash. Only one person is allowed in the back room at a time. No threats or aggression towards any member of the community (staff and students). No bad words or offensive terms are allowed. Kids are expected to respect these rules & could lose their privilege of coming here if they break them.

Karma Club, a nonprofit organization, is a teen center for 13-19-year olds located inside Northgate Mall.

By electronically signing below, I, the parent or legal guardian of the participating student, hereby acknowledge and agree to the following:


1. Assumption of Risk
I understand that attending Karma Club involves inherent risks,  including but not limited to transportation, physical activity, interaction with third parties, and being in new environments. I voluntarily assume all such risks associated with my child’s participation.

2. Release and Waiver
In consideration of my child’s attendance at Karma Club, I hereby RELEASE, WAIVE, DISCHARGE, AND HOLD HARMLESS Karma Club, its officers, directors, employees, volunteers, partners, and agents from any and all liability, claims, demands, actions, or causes of action arising out of or related to any loss, damage, injury, or illness that may be sustained by my child while participating in any program activity, whether caused by negligence or otherwise.

3. Medical Consent
In the event of an emergency, I authorize Karma Club staff or representatives to seek medical treatment for my child. I understand that I am financially responsible for any medical care required.

4. Transportation
I give permission for my child to be transported by Karma Club staff, volunteers, or contracted transportation providers as part of the program.

5. Media Release
I give permission for photos or videos of my child taken while attending Karma Club to be used in promotional materials, including print, web, and social media, unless I indicate otherwise in writing.

6. Code of Conduct
I understand that my child is expected to follow all program rules and respect staff, instructors, and fellow participants. Inappropriate behavior may result in dismissal from the center.

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