12/04/1995 Park Board Packet - Laserfiche WebLink

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ENROLLMENT IS EASY!! FINANCIAL ASSISTANCE AVAILABLE Financial assistance is available for all Lino Lakes Parks and Recreation activities and programs. For additional information,please contact the Parks and Recreation Department at 464-5562. DATA PRIVACY ADVISORY The following information about individuals who are enrolled in a City recreational or social program is classified as private data.The information which you provide to the City on the registration form is used to process your registration request,to determine City staff, facilities and equipment needs,and to assist coaches/supervisors in notifying participants of scheduling changes. You are not legally required to provide the information requested on the registration form. However,if you fail to provide the information,you will not be allowed to participate in the activity or program. The information which you provide will be made available to City staff persons in the Parks and Recreation Department,program participants,the City's insurer and attorney,and to the coach,supervisor,or instructor of the activity,who may be a City employee or volunteer. r------------------------------------------� REGISTRATION FORM -- Lino Lakes Parks and Recreation Make checks payable to City of Lino Lakes and mail to Lino Lakes Parks and Recreation,7204 Lake Drive,Lino Lakes,MN 55014. Or use the drop boxes located next to the entrances of the Lino Lakes Parks and Recreation Office,the community education office at Centennial Elementary School or the Lino Lakes City Hall. For more information call the Parks and Recreation Department at 464-5562. (NOTE.Separate check required for each program.) PARTICIPANT PHONE(day) (evening) ADDRESS CITY ZIP I Activity/Course Title Date/Time/Location Fee I • I I i IParticipant's Special Needs: Parents: Include your last name if it is different from your child's name: PARTICIPANT AGREEMENT:I,the participant,in consideration of my being permitted to participate in the activity,do hereby agree to hold harmless,the Lino Lakes IParks and Recreation Department,City of Lino Lakes,Centennial School District and their employees,and the Centennial School District from any and all liability 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 condition ofthe facilities Iand any improvements hereto. Partieipant/Guardian Date I , .-----------------------------------------� I REGISTRATION FORM -- Lino Lakes Parks and Recreation I Make checks payable to City of Lino Lakes and mail to Lino Lakes Parks and Recreation,7204 Lake Drive,Lino Lakes,MN 55014. Or use the drop boxes located next to the entrances of the Lino Lakes Parks and Recreation Office,the community education office at Centennial Elementary School or the Lino Lakes City Hall. For more information call the Parks and Recreation Department at 464-5562. (NOTE.Separate check required for each program.) PARTICIPANT PHONE(day) (evening) ADDRESS CITY ZIP I I Activity/Course Title Date/Time/Location Fee I I I I i Participant's Special Needs: I Parents: Include your last name if it is different from your child's name: I PARTICIPANT AGREEMENT:1,the participant,in consideration ofmy being permitted to participate in the activity,do hereby agree to hold harmless,the Lino Lakes Parks and Recreation Department,City of Lino Lakes,Centennial School District and their employees,and the Centennial School District from any and all liability 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 condition ofthe facilities and I any improvements hereto. Participant/Guardian Date I L—————————————————————————————————————————J Be sure to get your registration in to us in plenty of time. Programs fill fast!! If you need additional registration forms, contact the Parks and Recreation Department at 464-5562. 23