General Registration Information Template - Liability Waiver printable pdf download

EMPLOYER_____________________________ EMPLOYER____________________________________

EMERGENCY CONTACT NAME_______________________________ PHONE______________________

FAMILY EMAIL ADDRESS:_________________________________________________________

***PROGRAM REGISTERING FOR: __________________________________________________

PLEASE LIST ANY KNOWN FOOD ALLERGIES:_______________________________________

TEE SIZE: only applies to some programs-PLEASE CIRCLE SIZE

6-8

10-12

14-16

AD SM

AD MED

AD LG

AD XL

AD 2X

LIABILITY WAIVER

I, the undersigned, agree to participate or let my child participate in the Seneca Falls Recreation &

Parks Commission program indicated above. I understand and agree that the SENECA FALLS RECREATION

& PARKS COMMISSION, its DIRECTORS, MANAGERS, COACHES, TOWN of SENECA FALLS OFFICIALS

and OTHER ORGANIZERS shall in no way be held liable for any injury received at any meeting of the above

named program. I understand that it shall be my responsibility to transport my child or myself to and from this

program.

I do, hereby, assume all NORMAL risks and hazards incidental to the conduct of the above named

program. I further release, absolve, indemnify and hold blameless the SENECA FALLS RECREATION &

PARKS COMMISSION or any of the personnel appointed by that COMMISSION or the TOWN OF SENECA

FALLS.

_____________________________________________

_______________________________________

PARENT/GUARDIAN or PARTICPANT SIGNATURE

DATE

QUESTIONS? CONTACT THE SENECA FALLS REC/PARKS OFFICE AT 568-6933

DELIVER OR MAIL COMPLETED FORM WITH PAYMENT TO:

SENECA FALLS COMMUNITY CENTER, 35 WATER ST., SENECA FALLS, NY 13148

PLEASE PAY BY CHECK OR CASH. MAKE CHECKS PAYABLE TO: SENECA FALLS RECREATION.

CREDIT CARDS NOT ACCEPTED. THANK YOU!

General Registration Information Template - Liability Waiver

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