09/08/1992 Park Board Packet - Laserfiche WebLink

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r ----------------------t r--------------------- Lino Lakes Park and Recreation Dept® i Lino Lakes Park and Recreation Dept. REGISTRATION FORM I I REGISTRATION FORM PARTICIPANT 1 PARTICIPANT ADDRESS I I ADDRESS CITY ZIP I I CITY ZIP PHONE (day) (evening) I I PHONE (day) (evening) . : .: .. A .:... E AT 3t T C ............... M ; I I i 1 IF I PARTICIPANT AGREEMENT:I,the participant,in consideration of my being I I PARTICIPANT AGREEMENT:I,the participant,in consideration of my being permitted to participate in the activity,do hereby agree to hold harmless,the Lino I I permitted to participate in the activity,do hereby agree to hold harmless,the Lino Lakes Park and Recreation Department,City of Lino Lakes,Centennial School Lakes Park and Recreation Department,City of Lino Lakes,Centennial School District and their emplyoees,and the Centennial School District from any and all I I District and their emplyoees,and the Centennial School District from any and all liablility for any personal injury or death which may occur from my participation I I liablility for any personal injury or death which may occur from my participation in this activity. This waiver includes any injuries which may result from the g I in this activity. This waiver includes any injuries which may result from the condition of the facilities and any improvements hereto. 6 condition of the facilities and any improvements hereto. Participant/Guardian Date I I Participant/Guardian Date . tvtalie r1t8c1<S p Yable fo.icy.......... Lwn sakes.and 3 W to is,tnv Lakes par1K and I I Make chef ksW. Recreation, 1189 Ivtain Street,Iatlo Lakes,Mlv$ I4 O#tine the drop box` I I 32ecreaUoo II Ivie n str�tit 1.0L. Lakk, Mrl$©4 Or uacathe dries bote> locatedXXr :next to the elitr�rice of tha commuiuty education office at Centeruuat I located neiit to the entrance of the commtwitp education office ar Centennial .: etneritarySchcrvlornexttotheetttraneeaCthttuioIakeaCityHalt )Foitnore: ElementarySchoalornexttcrtftaentraneeattttelinoLejteaCityHalt 1Formor l farm$tivn callBa at464- 55 or 780 7686 I ►nformation call 13a,: at 464 5562 or.780-7686: L————————————————————J L————————————————————- r——————————-—————————, r———————————————————-- Lino Lakes Park and Recreation Dept. i Lino Lakes Park and Recreation Dept. REGISTRATION FORM I ( REGISTRATION FORM IPARTICIPANT I PARTICIPANT I ADDRESS 1 I ADDRESS CITY ZIP I I CITY ZIP PHONE (day) (evening) I I PHONE (day) (evening) I ACT te lDi %TIfEOCATIO I I .:ATTVIT DA /Tt1VIiLQCATION .; .: II _ II 11 II II I PARTICIPANT AGREEMENT:I,the participant,in consideration of my being I I PARTICIPANT AGREEMENT:I,the participant,in consideration of my being permitted to participate in the activity,do hereby agree to hold harmless,the Lino I I permitted to participate in the activity,do hereby agree to hold harmless,the Lino Lakes Park and Recreation Department,City of Lino Lakes,Centennial School Lakes Park and Recreation Department,City of Lino Lakes,Centennial School District and their emplyoees,and the Centennial School District from any and all 1 I District and their emplyoees,and the Centennial School District from any and all liablility for any personal injury or death which may occur from my participation I I liablility for any personal injury or death which may occur from my participation ',this activity. This waiver includes any injuries which may result from the I I in this activity. This waiver includes any injuries which may result from the )ndition of the facilities and any improvements hereto. condition of the facilities and any improvements hereto. I Participant/Guardian Date I I Participant/Guardian Date Maki i?}fim payable fo Cat<y O LIAO]f.al es attd itta t to 1 1 bal,a8 ar1c all$ Ma16 checks pal able tlo City of Lmo�akes and marl toLino Lakes 1partc and Recrestioa, lI:$9laut Street,l~t deg,i1gF 55tt14 Or i1Be CRtir:d bti I I RecreationI$9u�u.Strer,Lipo Lakea,lurr 55t)I4 Or use the drop fox located:next to rite entrance;of ttte eommutiity education office at Ceiitenrtlal I located next to the entrance tf the eammumty education office at Centennial Elementary School orne�Cty the entrance at ttic t.ino Lakea City Hattcir more I l✓Iemeittary School ornexttafifieantranee atthe tiino Lakeia CityHallormotc.: information call;Ha at 46445.6r1 or 780 7fi86 information call 13a ' at 464=5562 or:780 7686.; ;' L————————————————————J L—— —————— —————-