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<br />., <br /> <br />Attachment B <br /> <br />Sample Registration Cant <br /> <br />(S"x7" index card, front) <br /> <br />Facility Name <br />Pa.rlcs and Recreation Department <br />City! Town of <br /> <br />Applicant Information (please print) <br /> <br />Name: <br /> <br />Address: <br /> <br />CitylTown: <br /> <br />state! Zip: <br /> <br />Home phone: <br /> <br />Emergency contact: <br /> <br />Phone: <br /> <br />(SOx7" index card, back) <br /> <br />IIwe are aware of the nature of the skateboardfm-line skating activities available throughout the <br />Pa.rlcs and Recreation Department. J/we hereby give permission for my/our child to participate. <br /> <br />IIwe release the city/town of and its employees and agents from any <br />liability for injuries that may arise out of my/our child's participation in these skateboardfm-line <br />skating activities. <br /> <br />Parent/Guardian Signature: <br /> <br />Date: <br /> <br />Participate Signature: <br /> <br />Date: <br /> <br />Recreation Department <br />Representative Signature: <br /> <br />Date: <br />