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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