Geneva Park District Summer 2019 Program Guide Summer2019_ProgramGuide

Geneva Park District Program Registration 710 Western Avenue ~ Geneva, IL 60134 ~ P: 630-232-4542 ~ F: 630-232-4569 ~ genevaparks.org Last Name (Adult) First Name Address City Primary Phone Alternate Phone Email Address Work Phone Participants Name Birth Date Age/Grade State Program Name Zip Code # Refunds must be submitted 2 weeks prior to the 1st day of class. Fee Total Fees PERSONS WITH SPECIAL NEEDS: The Park District makes reasonable accommodations for persons with special needs to participate. Please specify any adaptive equipment, personnel or other accommodations you need to participate in a program for which you have registered. GENEVA PARK DISTRICT WAIVER AND RELEASE OF ALL CLAIMS The Geneva Park District (the “Park District”) is committed to conducting its recreation programs and activities in a safe manner and holds the safety of participants in high regard. The Park District continually strives to reduce such risks and insists that all participants follow safety rules and instructions that are designed to protect the participants’ safety. However, participants and parents/guardians of minors registering for this program/activity must recognize that there is an inherent risk of injury when choosing to participate in recreational activities. You are solely responsible for determining if you or your minor child/ward are physically fit and/or adequately skilled for recreational activities. It is always advisable, especially if the participant is pregnant, disabled in any way or recently suffered an illness, injury or impairment, to consult a physician before undertaking any physical activity. WARNING OF RISK Recreational activities are intended to challenge and engage the physical, mental and emotional resources of each participant. Despite careful and proper preparation, instruction, medical advice, conditioning and equipment, there is still a risk of serious injury when participating in any recreational activity. Depending on the particular activity, certain risks and dangers may exist due to inclement weather, slips and falls, poor skill level or conditioning, carelessness, horseplay, unsportsmanlike conduct, lack of safety equipment, inadequate or defective equipment, failure in supervision and instruction or officiating, and premises defects. It is impossible for the Park District to guarantee absolute safety. 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 the Program(s), 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 the program(s)/activity(ies) (including transportation services, when provided). I recognize and acknowledge that there are certain risks of physical injury to participants in the program(s)/activity(ies), and I voluntarily agree to assume the full risk of any injuries, damages or loss, regardless of severity that my minor child/ward or I may sustain as a result of participating in any and all activities connected with or associated with the program(s)/activity(ies). 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 Park District, including its officials, agents, volunteers and employees (hereinafter collectively referred as “Parties”). I do hereby fully release and forever discharge the Parties 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 the program(s)/activity(ies). I further indemnify and hold harmless the Park District. I have read and fully understand the above important information, warning of risk, assumption of risk and waiver and release of all claims. If registering on-line or via fax, my on-line or facsimile signature shall substitute for and have the same legal effect as an original form signature. PARTICIPATION WILL BE DENIED If the signature of adult participant or parent/guardian and date are not on this waiver. PHOTO/VIDEO DISCLAIMER: All participants permit the taking of photos and/or videos of themselves and their child/ward during Park District activities, programs, events, and use of parks and facilities for publication and use as the Park District deems necessary in marketing materials and social media avenues. If you and/or your child do not wish to be photographed or videotaped, a written objection must be filed with the Park District. PAYMENT Please indicate your choice of payment:  Check  Cash Card Number  Credit Card CVV Code Expiration Date NOTE: Faxed registration must be paid by credit card. When registering by fax, it is mutually understood that the facsimile registration documents (including the waiver & release of all claims) shall substitute for and have the same legal effects as the original form. SIGNATURE I have carefully read the Insurance Liability waiver on this form and understand that my signature is required below in order for myself or my child/ward to participate in the Geneva Park District programs. My signature also authorizes payment via the credit/debit card number if provided for payment. Signature of Participant, Parent or Guardian and Credit/Debit Card Holder if applicable Office Use Only Prepared by: Copy given to: Date Date: Amount: for: Pmt Method: Special Needs Personal Training Priv. Lesson RB/WB League Other_________________ Summer 2019 Registration starts May 7 103

Geneva Park District Summer 2019 Program Guide Summer2019_ProgramGuide | Page 103