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Holly Township Parks and Recreation REGISTRATION FORM |
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Contact Name:____________________________________________________________
Address:________________________________________ City:______________________ Zip:_________________
Phone:___________________________________________
Email:___________________________________________
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PLEASE READ AND SIGN The undersigned, on behalf of himself or herself, or as a parent or guardian of such individual, assumes all responsibility for the above participant while enrolled in the activities sponsored by the Parks &Recreation Department of Holly Township, with respect to any actions taken in pursuance of such activities, either before or after the activity. Moreover, it is agreed that the Township of Holly and its departments and employees shall not be liable for any property damage, and/or personal injury, and/or other loss or damage suffered by the participant, and the participant, an his or her own behalf, or as parent or guardian of participant, release and forever discharge each of the entities and persons from any and all actions, causes of actions, claims and demands with respect to any and all such damages, injury or loss. In the event of any injury, permission is hereby given to the Parks & Recreation Department of Holly Township, and to the Director, or his or her agent, or employee, to see that first aid and medical attention are given to the participant, at the discretion of the Parks & Recreation personnel. The participant represents that he or she is in good physical condition and able to participate in the activity for which he or she is enrolling, and shall be responsible for his or her own health, and acknowledges that the activity in which the participant is enrolling may be injurious, and participant accepts this risk with full knowledge. It is understood that there is a no refund policy except under extenuating situations which shall be determined by the parks board. Video recording may be done and/or pictures may be taken at certain Parks and Recreation parks, facilities, classes, programs and/or special events, and, unless the department receives signed, written objections, videos and photos may be reproduced for publication.
___________________________________________________________________________________________________ Participant Signature or Parent/Guardian Signature (if under 18) Date
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Participant Name |
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Age (If Under 18) |
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Event/Class Name |
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Session Time and Date |
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Fee |
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Holly Township |
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Parks and Recreation |
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*Drop off or mail checks and completed registration forms to:
Holly Township Parks 5142 East Holly Rd. Holly, MI 48442
*Please make checks payable to Holly Township Parks |
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