7/30/2019 Reg Form Ladies Tennis123 Tues 9am

http://slidepdf.com/reader/full/reg-form-ladies-tennis123-tues-9am 1/1

UNSIGNEDAND/OR INCOMPLETE REGISTRATION FORMSW|LL NOT BE PROCESSED.PLEASE TYPE OR PRINT IN INK.

PLtrASE PRINT

Iast Name of Adult Prticipantor t !:st Nme HmeffMe Work Phone

Address of Prtiripnt(s)

ACTTVITYCODE #

* ZslolCI-A*S.STITLE

lhr. ?rrvqt4lft.{P

ll

DA'IEg

sl?

DAYS&TIMEOF CLASS

Ttrrr ir,*-loe..^

TODAL

PAYMENT

slb.5o

ll,o,5,

llb.g,I b.50

NAME t}F FARIIUIPAN f

TENNISCOURT

TOCATION

Qts?S.s'? rr?o8 ilt+ flul' qr*r-10(n

2.r1oq 5lr r

51 18Ttr+ '1r..-lotn

5l0

aY?10 'Tug ?er-tglu Ssr

er?r/ bl+ Xas-trl'1er'd {b.50

{s(A Addtess and/or Phone Number has recently changed. Email address

tr Participant has special needs which require special accommodations. Explain

Endosed fi"d $

-

checkf Money Order n Master Card n VISA n

MasterCatd ot VISA Acct No. F'.xpiration Date

Signature (fot ctedit card authorization only) -

Citv

AGREEMENT WAIVER, AND RELEASEI have carefully read the descrifrtilxr of activiries for whbh Uwe are PARENTAL CONSENT: (Rqistration shall be completed and

resisrerins. and rn consideratiori for being perrnifted by dre Rancho signed by parent/guardian if applicant is r;nder 18 years of age).

SiFri ne&fon and Padi Disftict to saddpate tn the above activiry. "Iherebv conlent that rriy son/dauphter.

'namedaibove,

(described

in this brochure) Iherebv waive, release and discharse particigate in &e above activitv, and

Ihereby execute the above

iny and alt daims for damages for preisonal m;ury, dea*r, or poperty Agreeinsrt, Waffer, old Releas-e on his/her behalf. I state that said

da;lrsewhich I mayhave]orwhichmayher6afteraccruCtomg minoris physically able to participate in said activity. I hereby

^r ",6uk of particio'ation in said activiq/. This release is intended to asree to

-inaemnifi, and hbld d-r'e above District, its officers,

discturla in ilvar& dre Districq its officers. ernployees, and aEens eiirployees, and agdrts fue and hannless from any loss, liability,

from #v and all liabiliw adsiru; out of or conhe&ed in anv-wav darirase. cost or dbense which thq'mav inctr as a result of death 6r;dr ;y'prtb.qr"tion rn'said

".fioity,even thotrgh that liabilitjt nriy

^rry -j,nf' * ptp'.tty darnage ttttt tria minor may sustain whilearise oit bf

"d;Eoroot o,.lo*ris on the paft of *re Dirni.q tts prid"i.*s ito r1"id

'acti"itv] I hereby eive ptr;ission to the.

officers- ernolo:vfo- and aoents. It is undersiood *rat dris activiw ifanchb Sirii Recreation and pad< Disfia to use mn or mv child's

involves utr'.Li"*t of risE and danger of accidents and knos'ing photogaph as ftey see fit in their recreatiori- brochure. Idrose risks I herebv assurne *rose risfii. It is firther aseed *rat *,fi i-aer*"t^nd the ohot6oraohs belons to the Rancho Simi Recreation

*riuo, r.l*"g and assumption of risk is to be binrfinE on my heirs and Park Distnct, andi .ifll not r..?ioe payrnent of any kindand asiBrn f aple to tn&innify and to hdd *re Dst&t ib dtrffi. I HAVE CAREiTULLY READ THISAGREEMENT,onployEes,

".tEug.tttr ftee a;d hannless frorn any loss, liability, WAM& Al{D RELEASE AftD FLLLY LJFIDERSTAND ITS

dar-n4Ee cast" or expeneq uihich thw may incr;r as fte rcsult qf deadl CONTEIT{TS I AM AWARE THAT THIS XS A RELfiASE OF

"t,Tl i"i"ry * pr"paqvdaqage lhat iaid participant may sustain LIABILITY AftD A CONTRACT BETWEEN MYSELF ANDwh]le paftdpaflngrn sard actrflty. THE ABOVE DISTRICT, ITS OFFICERS, EMPLOYEESA}[D AGENTS AND I SIGN IT OF vIY FREE WILL.

Signature of adult (participant,parent/guardian) for Agreementn Waiver and Release Date

MAIL REGISTRATION TO:OAK PARK RECREATTON OFFICE

1000 N. Kanan Road, OakParECaIfomn9l.3TT ' Phone: (818) 865-9304'Fax (818) 874-0064

DID YOU REMEMBER TO INCLUDE PAYMENT? YOU wlLL NOT RECEIVE CONFIRMATION.

OAK PARK RECREATION