Lyons Community Center - Online Registration

Online Registration

Lyons Community Center
Online Registration Form

Programs

Is there a specific program under the heading you chose?
For example; Biddie League, Regular Hours, Extended Hours.

Child's Name

Child's DOB

Parent Guardian

Street address

Address line 2

City

State

Zip

Phone

Email

Can Your child swim?

Yes
No

Is there anything else we should know?

Have you read and agree to the terms and agreements to the right?

Yes
No

Please sign your name in all capital letters. This is equivalent to your
signature in ink.

Today's Date

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IMPORTANT INFORMATION

You are solely responsible for determining if you and/or your child is physically fit and/or adequately skilled for the activities associated with the program you choose to participate in. It is always advisable, especially if the participant is pregnant, suffers from an underlining medical condition, takes medication, smokes cigarettes, has a family history of coronary disease, or has recently suffered an illness, injury or impairment, to consult a physician before undertaking any Lyons Community Center Activities.

WAIVER AND RELEASE OF ALL CLAIMS AND ASSUMPTION OF RISK

Please read this language carefully and be aware that in signing up and participating in any Lyons Community Center program, you will be expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or loss which you and/or your child might sustain as a result of participating in any and all activities connected with and associated with the program you choose to enroll yourself and/or your child. In consideration for your participation in Lyons Community Center Programs you will be expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or loss which you might sustain as a result of participating in any and all activities connected with and associated with your participation. I recognize and acknowledge that there are certain risks of physical injury to Lyons Community Center programs, and I voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that I may sustain as a result of said program. I further agree to waive and relinquish all claims I may have (or accrue to me) as a result of my participation against the Lyons Community Center, including its officials, agents, volunteers and employees.

PHOTO/VIDEO AUTHORIZATION AND CONSENT

I hereby authorize and give my consent to the Lyons Community Center to photograph/video my child (or me), and without limitation, to use such photographs/video in connection with promoting/advertising the services, programs, and facilities of the Lyons Community Center, without consideration of any kind. I have read, fully understand, and agree to the above Lyons Community Center Agreement terms. If registering on-line or via fax, my on-line or facsimile signature shall substitute for and have the same legal effect as an original form.