10.2. SR 08-07-2017 - Laserfiche WebLink

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38 Registration Forms 763.635.1150 www.ElkRiverMN.gov/Register Parent/Guardian Name ________________________________________________ DOB:__________________ Address ____________________________________ City ___________________ Zip _________________ Home Phone ______________________________ Cell Phone ______________________________________ E-mail Address ______________________________________________________________________________ STUDENT NAME ______________________________________ Age: _______ DOB: _________________ Any Special Needs? __________________________________________________________________________ Course Name and # Fee ________________________________ ______ ________________________________ ______ ________________________________ ______ Payment Cash ______ Check ______ Check # ___________ Credit Card # ________________________________ Expires _________ Signature ___________________ Print name on card ____________________________ In consideration of your accepting my child’s entry or my entry, I hereby, for myself, my child, my heirs, executors and administrators, waiver and release any and all rights and claims for damages I or my child may have against the City of Elk River, the Parks and Recreation Department, successors and assigns for any and all injuries suffered by myself or my child at any activity sponsored by these groups. I do hereby allow the City of Elk River to use any photographs or video taken by the City, of the individual(s) named herein, in city informational publications released to the general public. Signature _________________________________________________ Elk River Parks and Recreation Registration Form Elk River Parks and Recreation Registration Form Parent/Guardian Name ________________________________________________ DOB:__________________ Address ____________________________________ City ___________________ Zip _________________ Home Phone ______________________________ Cell Phone ______________________________________ E-mail Address ______________________________________________________________________________ STUDENT NAME ______________________________________ Age: _______ DOB: _________________ Any Special Needs? __________________________________________________________________________ Course Name and # Fee ________________________________ ______ ________________________________ ______ ________________________________ ______ Payment Cash ______ Check ______ Check # ___________ Credit Card # _________________________________ Expires _________ Signature ____________________ Print name on card ______________________________ In consideration of your accepting my child’s entry or my entry, I hereby, for myself, my child, my heirs, executors and administrators, waiver and release any and all rights and claims for damages I or my child may have against the City of Elk River, the Parks and Recreation Department, successors and assigns for any and all injuries suffered by myself or my child at any activity sponsored by these groups. I do hereby allow the City of Elk River to use any photographs or video taken by the City, of the individual(s) named herein, in city informational publications released to the general public. Signature _________________________________________________