Open Gym

By completing this form the participant agrees to cooperate with the rules, regulations and recreation staff.

Participant's Name*
Age
Grade
Gender
- Male
- Female
Address
Street Address City ZIP Code
Parent/Guardian Name(s)
Home Phone
Work Phone
Email
Medical Restrictions
Please list any medical restrictions:
Emergency Contact Name*
First Last
Emergency Contact Phone*
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 Open Gym 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 Open Gym, 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 conditions