Get documents about "waiver
Document Sample
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Name:
Address:
City:
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O.O.B. :
Phone#: (
Zlp:
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Age: _
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Father's Name: List Two Neighbors or Relatives in case of
Home Phone: ---------
Work: --------- _ Emergency:
Name: _
Address: _
Mother's Name: Phone: _
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Home PhOne: _ ••. -_-_-_-_ -_-_-_-_-_-_-_-_-_-_-_
Name:. _
Work:
------------ Address:
Phone:
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HEALTH INFORMATION
List any conditions that your child may have:. _
Hospital Preferred: Physician Preferred: _
I. the undersigned do herby authorize officials of the City of laredo Parks and Recreation Oepartment to
contact directly the persons named above and do authorize the named physiclans Ie render such treatment
as may be deemed necessary In an emergency. In the event person named on this card cannot be
contacted, PAR.O. persQl1nel are h8lby authorized to seek medical attention necessary in their j"!dgment for
the treatment of the aforesaid individual. I will not hold the City of Laredo financially responsible for the
emergency care and or ttanspOrtauon. '
Signature:
General Hobbies . Recreational Hobbies
o Arts & Crafts o Entertainment o Aerobics 0 Racquetball
o Baseball 0 Rock Climbing
0 Arts & Humanities o Government .0 Basketball 0 Running! Jogging
1J. 0 Automobiles o -------Science
Health &
0
o
Board Games
Boxing
0 Skateboarding
0 Softball
o 0 Business & Economy 0
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Society & Culture
0
o
Cycling
Dancing
0 Soccer
0 Swimming
o Football 0 Tennis
-0
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Computers & Intemet o Handball
o Hiking
0 Volleyball
0 Weight Lifting
0 Education o Lacrosse 0 YOgal Pilates
o Martial Arts
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, ..:-:.';. .•. - •...... photography Pennission Liability and Hold Harmless Release
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Know all men by these present. that we. and
_____________ . being the parents and for legal guardians of
____________ 0:--' . the City of Laredo Parks and Recreations
participant will agree to the below mentioned terms.
I hereby grant the City of Laredo, Parks and Recreation Department pennission to take
pictures of my (son I daughter). on any activity or
trip performed by the City of Laredo Parks and Recreation Department for personal use of
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-~... the department or for non-profit advertising of the same, We hereby release, indemnify and
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hold harmleSs the Clly· of laredo, Ifs elected and appointed officials, employees and
VDlunteer8 assisting on behalf of the City of Laredo frOm any and all dalms. suits.
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demands, cause of aettons, IlabUltles. Including all costs and expenses connected
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therewith, including reasonable attorney's fees, for personal injury, property or any other
harm that may ",suit In the event of an accident or mishap that 1¬ due to the City of
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Laredo's negligence •
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Further, that this waiver shall apply to (child's name)
. durJng the entire period of time of his I her membership of the department or during
participation in any Parks and Recreation sponsored event and time forth. Any and all
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phOtography is the sole property of the City of Laredo Parks and Recreation and may be
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used for any and all publiclt;y reasons or events that this department sees fit.
we warrant that we have read. this fun release and fully understand it as a release for the
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above - descrl)ed matter. We further warrant that no representation of any kind or
character has been made to us by any person as an Inducement for the execution of this
lelease. and that the undersigned are of legal age, and are JegaUy competent to execute
this release.
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Signature of Parent Date
WAIVER AND RELEASE
I. undersigned do herby release and agree not to hold liable the City of Laredo. its OffICers,
agents and- employees from any and all actions. cause of actions; claims, demands, costs
and damages as a result Of property damage or personal Injuries sustained of his or her
property, arising from or. resUlting from any act or omission, negligence or otherwise of the
said City of Laredo. Its officers,agents and employees or any other persons or other
participants in the program while participating in ·the said activities or while traveling to and
from the place at which such activities will be conducted.
Comments:. _
Signature: - Date: _
Membership Renewal
carel # Signature ---Date _
" Card # Signature Date
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1(.__ . Card , Signature - O.ate _
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Card # Signature ...o-._.08te _
r .•.... Card • Signature O.ate _
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Registered by (Print Name) Date Enta'ed by Date__ --
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. Receipti# _
