Laserfiche WebLink
� � $:11 W <br /> � N , � N N M � O �' ■ <br /> WON ~ O 0 O O •~ <br /> 0� 4—J 7� O <br /> CJ <br /> � O E \ <br /> 7� <br /> � ;5 <br /> r� �, <br /> _ O <br /> N 4J N N 4J 4J 4�0 <br /> V W cr <br /> ct <br /> 4-J o N M �n �o ►� c O <br /> �+ p -� 4mo <br /> N-40- O o0 CD °o 00 °o °o 00 00 <br /> M r-� p o <br /> I� a) a) a) a) a) <br /> ;Z 4■■0 <br /> WD an,� <br /> r� <br /> fu <br /> 4—J W11� <br /> 4=0 <br /> a 0 <br /> o <br /> ANNO <br /> a� A 7:� O <br /> ct <br /> ct <br /> oo - <br /> 4� rA <br /> Rho U a <br /> Bib <br /> Qoo 4=0� <br /> M � <br /> M M M M <br /> o o <br /> ..................................................................................................................................................................................................................................................................................................................................................................................................................... <br /> Register Online:http://www.cityofroseville.com/skatingcenter <br /> Participants Name: Phone: Parent/Guardian <br /> Name: <br /> Home Address: City: State: Zip: <br /> ~ GENDER(circle one): F M BIRTHDATE: STATUS: New Student Returning Student <br /> 'Ak VW PROGRAM#: PROGRAM NAME: TEST PASSED: <br /> dft <br /> Lo Does participant have any disability,allergy orspecial need of which we should be aware? Explain: <br /> cD Liability Waiver:I understand that participation in this activity is completely voluntary.I recognize that there are risks in my participation in this activity.I agree to <br /> 2 <br /> PAO qw •> A accept those risks.I also agree,in consideration for my being allowed to participate in this activity,and on behalf of myself,my heir,executors,administrators <br /> U '> a� <br /> and assigns,to release and discharge the City or Roseville,sponsor(s)of the event or activity,and their officers,employees,agents,successors and/or assigns from <br /> (5 o Lo <br /> cv co liability for any and all injury,damage or loss that is or may arise from my participation in this activity. <br /> Data Practices Act Notice:Pursuant to the Minnesota Government Data Practices Act,you are being requested to furnish certain information that is classified as <br /> f <br /> private under the Act.The City collects such information in order to properly process requests to participate in activities.You may refuse to provide such information, <br /> tip but such a refusal may affect your ability to participate.The information will be maintained by the City Park and Recreation Department,and may be accessible to <br /> r <br /> anyone in the Department,or in other Departments of the City. <br /> Signature: Date: E-Mail: <br /> Fee Paid Date Paid Check# B <br /> Visa or MasterCard# Exp Date <br />