Drama
Class Registration Form
The undersigned shall be solely responsible for and shall hold harmless, release and discharge the CITY OF JOLIET and its officers and agents, employees and the WILL-JOLIET BICENTENNIAL PARK, INC and its officers, agents, and employers against all injuries, death, losses, damages, claims, suits, liabilities, causes of action, judgments, costs, and expenses, including attorney's fees, which may in any way accrue directly or indirectly against the CITY OF JOLIET and its officers, agents, and employees and the WILL-JOLIET BICENTENNIAL PARK, INC and its officers, agents, and employees as a result of the undersigned's participation in any program, function, or event sponsored by the WILL-JOLIET BICENTENNIAL PARK, INC or held on the premises of the WILL-JOLIET BICENTENNIAL PARK, INC.
The undersigned understands that this document is a RELEASE OF LIABILITY and has signed the document freely and voluntarily (or, in the case of a minor, the minor's parent or guardian has signed it freely and voluntarily on behalf of the minor).
Student's name (please print):
Age: Birthday: Grade:
If summer, list fall grade
Address:
City, Zip: E-mail:
Home phone: Cell:
Emergency
phone:
Approved adult chaperones:
1.
Name: Relation: Phone:
2.
Name: Relation: Phone:
3.
Name: Relation: Phone:
If you need to add a chaperone later or
give approval to carpool, you must contact the teacher and provide written
consent.
Anyone NOT allowed contact:
Adult's signature:
Adult's name (please print):
Please
state relation to student
Date signed:
For additional safety
during summer, please advise your children NO FLIP-FLOPS are to be worn.
If new, how did you find out
about the class?(optional):
Please
make payment to: Location: Contact:
201
West
bicentennial
park
