Current
Grade ______________

 

ACTIVITY___________________________________________________________________

 

TOTAL FEE ENCLOSED __________

 

E-MAIL ADDRESS _____________________________________________

 

PARTICIPANT NAME_______________________________________________________________

 

ADDRESS_____________________________CITY____________________

 

AGE____________________ BIRTHDAY _______________

 

PARENT/GUARDIAN _____________________

 

HOME PHONE ____________________________

 

WORK & CELL PHONE ______________________________

 

DOES THE PARTICIPANT HAVE ANY SPECIFIC LIMITATIONS WE SHOULD BE AWARE OF?

___________________________________________________________________________

 

T-Shirt Size   (Please Circle One)   Youth Med.    Youth Large    Adult Small    Adult Med.

 

 

Signature: 

________________________________________

 

By signing, you agree to the terms outlined below: 

 

I (Parent/Guardian) agree not to hold the Casselton Park District, its employees or volunteers liable for any injuries or accidents that may occur during parks and recreation activities or programs.  I will not file any claims or seek damages from the park district, its board of directors or its employees.