Town of South Kingstown - Recreation Department - Recreation Department - Programs Registration Form
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Wednesday, July 23, 2008  
PROGRAM REGISTRATION FORM
Return completed form and fee to:
South Kingstown Parks and Recreation
325 Columbia Street, Peace Dale, Rhode Island 02883
(401) 789-9301

Make checks payable to: SKRC
Participant's Name Date of Birth Class / Program Code Number Dates Time Fee
       
       
       
       
       
TOTAL:
You will NOT be notified of enrollment unless difficulty is encountered.
Please keep a record of dates and times of programs. Refunds must be requested prior to the second class meeting.

RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT
I agree to the unreserved use of my name and/or likeness (including photographs, videotapes and other depictions) for publicizing South Kingstown Park and Recreation Department activities. In CONSIDERATION of the acceptance of the application for entry into the classes or activities listed above, I hereby WAIVE, RELEASE and DISCHARGE any and all claims for damages for death, personal injury or property damage which I may have, or which may hereafter accrue to me as a result of my participation in said classes or activities. This release is intended to discharge in advance the town of South Kingstown, the Town Council, the South Kingstown Recreation Commission, its officers, agents and employees from and against any and all liability arising out of or connected with my participation in said classes or activities. I HAVE READ THE DESCRIPTION IN THE BROCHURE OF EACH CLASS OR ACTIVITY FOR WHICH I HAVE REGISTERED AND I AM AWARE THAT THESE CLASSES OR ACTIVITIES SUBJECT ME TO PHYSICAL RISKS AND DANGERS. NEVERTHELESS, I VOLUNTARILY AGREE TO ASSUME ANY AND ALL RISKS OF INJURY OR DEATH, AND TO RELEASE, DISCHARGE AND HOLD HARMLESS ALL OF THE ENTITIES OR PERSONS MENTIONED ABOVE. It is understood and agreed that this waiver, release and assumption of risk is to be binding on my HEIRS, PERSONAL REPRESENTATIVES, NEXT OF KIN, SPOUSE AND ASSIGNS.
Parent or guardian must sign for youth 18 and under. Signature indicates registrant agrees with all registration and refund policies. Registration is not complete without signature.

Signature of Registrant:
Address: Town: Zip:
Phone (day): Phone (evening):

OFFICIAL USE ONLY        CHECK   VISA/MC   CASH    Registrar _____Received _____Recorded _____



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South Kingstown Parks and Recreation Department
325 Columbia Street  .  Peace Dale, RI  02883
Tel. (401) 789-9301    Fax. (401) 792-9617

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