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Liability Waiver for Participant:  As a participant (or as a parent of a participant under 18 years of age) in Ridgeville Park District programs, I recognize and acknowledge that there are certain risks of physical injury, and I agree to assume the full risk of any injuries, including death, damages or loss which I may sustain as a result of participating in any and all activities connected with or associated with the program(s). I do hereby fully release and discharge the Ridgeville Park District, their officers, agents, servants and employees from any and all claims from injuries, including death, damages or loss, which I may have or which may accrue to me on account of my participation in the program(s).  I further agree to indemnify and hold harmless and defend the Ridgeville Park District, their officers, agents, servants and employees from any and all claims from injuries, including death, damages or loss, which I may have or which may accrue to me on account of my participation in the program(s). I further agree to indemnify and hold harmless and defend the Ridgeville Park District, their officers, agents, servants and employees from any and all claims resulting from injuries, including death, damages and losses sustained by me and arising out of, connected with, or in any way associated with the activities of the program(s). I also hereby consent to the use of my photograph in Ridgeville Park District brochures, publications, website, presentations, etc.  I HAVE FULLY READ AND UNDERSTAND THE FOREGOING.

Guardian's  LAST NAME:_______________________ FIRST NAME: ______________

ADDRESS:___________________________CITY:__________STATE____ ZIP:_______

EMERGENCY PHONE: (  )___________________HOME PHONE: (  )__________________

CELL PHONE: (  )__________________________ PRINT Email:________________________

To keep our records straight, check off: Do you want to receive e-mails from us? ❏ Yes ❏ no

❏ name change ❏ address change

PARTICIPANT’S LAST NAME:______________________FIRST NAME:___________________

SEX_ ________BIRTH DATE: __________________  Shirt Size: _______

PROGRAM NAME                                  DAY         TIME              PROGRAM FEE

1._____________________________________________________ $_____________________

DISCOUNT: ❏ Multiples ❏ Seniors

Scholarship Fund Contribution $__________

TOTAL Enclosed: $____________ Do Not Mail Cash!

Make checks payable to:

Ridgeville Park District

and mail to: 908 Seward St.,

Evanston, IL 60202

Signature:__________________________________Date:_______/___/_____

Registering In person:

You may register Monday through Friday at our office between the hours of 9 am to noon and 1–5 pm.  In case of class changes or program cancellation, we will notify you in advance by telephone or Email.  Generally, refunds will be issued no later than 4 weeks after the beginning of the session. In the case of individual class cancellations, a make-up class may be scheduled by the instructor during the week following our last scheduled week of classes.               Receipt #___________