Playground Experience By completing this form the participant agrees to cooperate with the rules, regulations and recreation staff. NOTE:*Registration is NOT complete until payment received by the City of Oberlin Recreation Department.I have read and understand the terms and conditionsParticipant's Name*Address Street Address City ZIP Code AgeGradeGenderMaleFemaleShoe Size (for bowling trips):*T-Shirt Size (for craft projects):*My Child Attends: (check all that apply) WAVE Program Kindercamp Parent/Guardian Name(s)*Home Phone*Work PhoneEmail Medical RestrictionsPlease list any medical restrictions:Emergency Contact Name* First Last Emergency Contact Phone*Parent/Guardian Pick-Up*For the safety of the children participating in Recreation programming, parents/guardians must indicate those individuals who are authorized to pick up their child/children from the program and indicate if they are permitted to walk/bike from the program by themselves. Regardless if the child is permitted to walk/bike to and from the program by themselves, individuals authorized to pick up the child must be specified below (including yourself).I have read and understand the terms and conditionsIndividual Authorized to Pick-Up Child* First Last Pick-Up Individual Phone*Individual Authorized to Pick-Up Child First Last Pick-Up Individual PhoneIndividual Authorized to Pick-Up Child First Last Pick-Up Individual PhoneChild/Children Pick-Up Authorization*I authorize the individual(s) listed above to pick up my child/children from the Playground Program in which they are enrolled. I understand that those individuals listed must present the proper authorization card issued by the City of Oberlin Recreation Division before the child/children will be released to them. Further i understand that it is my responsibility to notify the Recreation Division should there be any deviations to this authorization. Lastly, I acknowledge that I have received a copy of the City of Oberlin Recreation Division Child Release Procedures, and that it is my responsibility to read, understand and comply with these procedures. I have read and understand the terms and conditionsIs this child permitted to walk/bike to and from this program? YES No If yes please specify the days:Participant Waiver of Responsibility*As a participant, or parent or guardian of a participant, permission is granted to participate in the City of Oberlin Recreation Division listed below. Participants understand and agree that they may be photographed and/or videotaped for promotion of City of Oberlin programs and waive any rights of compensation or ownership thereto. I, the undersigned, by participating in Playground Experience sponsored by the City of Oberlin, understand that such activity has certain inherent risks that may result in injury that can be serious, life limiting, or life threatening. I, the undersigned, do hereby release the City of Oberlin, its elected officials, employees, agents and volunteers from any and all claims resulting from any and all injuries sustained while participating in Playground Experience, except those arising out of the sole negligence of the City of Oberlin, its elected officials, employees, agents and volunteers. If participant is a minor (under the age of 18), a parent or legal guardian must sign this form.I have read and understand the terms and conditionsNameThis field is for validation purposes and should be left unchanged.
