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Registration Form

Family Last Name

Parent’s Name

Address

City

Zip

Home Phone

Business Phone

I n addition to Beyond the Bell Newsletter emails, please include me

Email Address

in the Resident Insider email newsletter, which contains information

on upcoming Parks & Rec programs, classes, and special events.

ADA COMPLIANCE: Please notify staff at time of registration if you require special accessibility or accommodations for your participation in these programs.

Student First Name

Age

Birthdate

Sex

Code/Sec

Class

Regist. Fee

Monthly Fee

WAIVER AND RELEASE OF ALL CLAIMS

Please read this form carefully and be aware that in signing up and participating in the above identified programs/activities, you will be expressly assuming the risk and legal

liability and waiving and releasing all claims for injuries, damages or loss which you or your minor child/ward might sustain as a result of participating in any and all activities

connected with and associated with said programs/activities (including transportation, when provided).

I recognize and acknowledge that there are certain risks of physical injury to participants in these programs/activities and I voluntarily agree to assume the full risk of any

and all injuries, damages or loss, regardless of severity, that my minor child and/or I may sustain as a result of said participation. I further agree to waive and relinquish all

claims I or my child/ward may be entitled to (or accrue to me or my child/ward) as a result of participating in these programs/activities against the Village of Lake in the Hills

Parks & Recreation Department including its officials, agents, volunteers and employees.

I do hereby fully release and forever discharge the Village of Lake in the Hills from any and all claims for injuries, damages or loss that my minor child/ward or I may have or

which may accrue to me or my minor child/ward and arising out of, connected with, or in any way associated with these programs/activities.

Participants registering or their parents hereby permit the taking of photos, audio and videotaping during the Parks & Recreation Department activities for publication and

use as the Village deems appropriate.

I have read and fully understand the above information, warning of risk, assumption of risk and waiver and release of all claims.

Signature of Participant or Guardian

OFFICE USE ONLY

AUG/SEP

FEB

$_____________ Method_____________ Late Fees_____________ Date_____________

OCT

MAR

$_____________ Method_____________ Late Fees_____________ Date_____________

NOV

APR