Brochure Winter 2019 - Page 46

HOW TO REGISTER FOR RECREATION PROGRAMS Fill out all five parts of this form carefully. Incomplete or inaccurate information will delay your registration. • New residents or changes in residency within the park district boundaries are required to provide proof (gas, electric or water bill, current tax bill, purchase agreement or lease. A driver’s license is not acceptable proof of residency). • Registration confirmation is provided in the form of a receipt: you may choose email or printed receipt • This form covers all park district recreation programs, unless otherwise indicated. See General Registration Information for important registration information, refund and transfer policy, waitlist policy, etc. 1 Fill in information for head of household – please print clearly Adult Registrant or Parent/Guardian Name_________________________________________________________________________________________________ Address___________________________________________________ City_________________________________________ Zip Code______________________ Primary Phone (_________)________________________________________ Business Phone (_________)____________________________________________ Email________________________________________________________________________________________________________________________________ 2 Fill in programs for each participant – please print clearly Class ID# Program Name Participant’s First & Last Name Sex Birthdate Grade School Fee 950000-A I would like to make a donation to the Glenview Park District Leisureship Fund in the amount of (fill in amount under “Fee”): 3 4 Total Fees Nonresident fees are generally 25% higher (unless otherwise indicated), up to a maximum of $100. In accordance with the Americans with Disabilities Act, describe any accommodation needed for your enjoyment of this program: Check to indicate that participant(s) requires assistance from NSSRA. Complete payment information (make checks payable to the Glenview Park District) ___ Visa ___ MasterCard ___ Discover ___ Cash ___ Check Card Number __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __ Card Holder (print name)_________________________________________________ Amount of Payment___________________________________________________ Expiration Date_____________________________________ Authorized Signature________________________________________________________________ 5 Sign the waiver PARTICIPATION WILL BE DENIED if signature of adult participant or parent/guardian and date are not on this waiver. Waiver and Release of All Claims and Assumption of Risk Please read this form carefully and be aware that in signing up and participating in this program/activity, 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 this program/activity (including transportation services/vehicle operation, when provided). I recognize and acknowledge that there are certain risks of physical injury to participants in this program/activity, and I voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that my minor child/ward or I may sustain as a result of said participation. I further agree to waive and relinquish all claims I or my minor child/ward may have (or accrue to me or my child/ward) as a result of participating in this program/activity against the Glenview Park District, including its officials, agents, volunteers and employees (hereinafter collectively referred as “Glenview Park District”). I do hereby fully release and forever discharge the Glenview Park District 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 this program/activity. I understand that photos and videos are periodically taken of people participating in Glenview Park District programs and activities and I agree that any photograph or videotape taken by the park district of me or my minor child/ward while participating in a park district program or activity may be used by the park district for promotional purposes including its electronic media, videotapes, brochures, flyers and other publications without additional prior notice, permission or compensation to the participant. I have read and fully understand the above important information, warning of risk, assumption of risk and waiver and release of all claims as well as the general registration policies. If registering via fax, my facsimile signature shall substitute for and have the same legal effect as an original form signature. 7 6 42 Signature of Participant or Parent (if participant is under 18 years) Return your form to the park district: Date Park Center, 2400 Chestnut Ave., Glenview, Suite P, IL 60026 • Fax: 847-657-6231. Email: Resident Priority Registration begins at 9 am on Th, November 8. General Registration begins at 9 am on M, November 19. ▪ REGISTRATION FORM