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Seepreviouspageforcompleteinstructions.Pre-registrationisrequiredforallactivitiesexceptwherenoted.Activitiesarelledaccordingtoregistrationdate.RegisterearlyHelpusavoidthecancellationofprograms.MailorbringyourcompletedRegistrationFormwithpaymenttoAshlandParksRecreationCommissionupperLithiaParkoffGraniteSt340SPioneerStAshlandOR97520.OrfaxyourcompletedRegistrationFormincludingcreditcardinformationtotheParksRecreationMainOfceat541.488.5314ortheNorthMountainParkNatureCenterat541.488.6607.DateofBirth______________ParticipantsName_________________________________________________________________MFmmddyyyyParentsGuardiansNameifunder18__________________________________________________________________________ResidentialAddress___________________________________________________________________________________________City___________________________________________________State_______________________Zip______________________PhoneNumbersHome_______________________________Work_______________________Cell______________________E-MailAddress_______________________________________________________________________________________________Youremailaddressisonlyusedtoprovideyouwithinstantconfirmationandaprintablereceipt.EmergencyContactName__________________________________________________________Phone______________________ActivitySessionDatesAmount_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Cash_______________MakecheckspayabletoAPRCCheck_____________Total______________CreditCardNumber___________________________________________________________circleoneVISAMCAMEXNameonCardprint_________________________________ExpDate_______________3-DigitSecurityCodeonbackofcard______Signature__________________________________________________________________________Date_____________________PLEASENOTEPRIORTOENROLLMENTINANYASHLANDPARKSRECREATIONACTIVITYYOUMUSTSIGNACURRENTYEARLIABILITYWAIVER.ONLYONELIABILITYWAIVERPERCALENDARYEARISNEEDED.LiabilityWaiverrequiredNameofParticipant______________________________________________________________________________IherebycertifythatIam18yearsofageorolder.IfIamtheparentorlegalguardianofaparticipantwhoisunder18yearsofageIagreethatthefollowingprovisionsshallapplytothatparticipationandagreetobefullyboundbythem.IunderstandthatparticipationintheAshlandParksandRecreationCommissionAPRCrecreationalactivityinvolvesriskofinjuryordeath.Participantisnotaffectedbyanyphysicalcon-ditionordisabilitythatwouldmakeparticipationunsafe.IunderstandthatAPRCwillnotprovidemedicaltreatmentandIauthorizeAPRCtoarrangeforanynecessarytransportationintheeventofanaccidentoremergency.FormyselfmyheirsassignsoranyonewhomightclaimonmybehalfIvoluntarilyassumeallrisksofparticipatinginthisactivityandIwaivereleaseandforeverdischargeanyclaimagainstAPRCitsofcersagentsandemployeesagainstanyclaimlossliabilityorexpenseincludingattorneysfeesthatmaydirectlyorindirectlyresultfromparticipationinthisactivityeventhoughthatliabilitymayariseoutofthenegligenceorcarelessnessofthepersonsorpartiesnamedinthiswaiverandrelease.SignaturerequiredDate_____________________ofParticipantorParentGuardianifunder18yearsofageInstructionsSeepage4ofRecreationGuideforcompleteregistrationscheduleoptionsandrefundpolicy.RegistrationFormashlandparksrecreationcommissioncommissionEst190847AshlandParksRecreationCommission541.488.5340340SPioneerAshlandOR97520www.AshlandParksandRec.orgLIKEusatFacebook.comAshlandParksandRec