2009-01-06_PR Comm Packet - Laserfiche WebLink

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participation in this activity.loss that is or may arise from my signs from liability for any and all injury, damage or employees, agents, successors and/or asdischarge the City of Roseville, sponsors of the event or activity, and their officers, xecutors, administrators and assigns, to release and on behalf of myself, my heir, eparticipate in this activity, and risks. I also agree, in consideration for my being allowed to in this activity. I agree to accept those voluntary. I recognize that there are risks in my participation I understand that participation in this activity is completely Liability Waiver: ogram. rticipating in the prou/your child from paformation, failure to do so will prevent yare not legally required to disclose the in , City Attorney, insurer and auditor. Although you ity staff, volunteersded to appropriate Cnumber and health information will be proviname, age, grade level, address, telephone nt needs. You/your child’s ine staff, faculty and equipmeto verify eligibility and determ The information requested on the registration form will be used Tennessen Warning: www.cityofroseville.com/parks 651--792-7100 Fax - 651-792-7110 ,Phone - c Center Drive - Roseville, MN 55113 Roseville Parks and Recreation - 2660 Civi Register in person, by mail, fax, on-line, or by calling Fee Enclosed:_______________ Paid by: Check____ Cash___ Credit Card - Visa____ MC____ AMX____ Program #:_______________ Program #:_______________ Program #:_______________ Program #:_______________ Home Phone:__________________ Work or other Phone:___________________ E-Mail________________________________ Address:_______________________________________________________ City:___________________ State_____ Zip:_________ Name:________________________Date of Birth _______________Name:___________________________ Date of Birth ______________ Name:________________________Date of Birth _______________Name:___________________________ Date of Birth ______________ City of Roseville Park and Recreation with youth and community health. ors were collegiate athletes and have worked with the nsas-Little Rock. Both instructhealth science from the University of Arka on from the University of St. Thomas and Brandon holds a degree in a better well-being. Kalsey holds a degree in health promoti ealthy lifestyles and have a passion for helping others to Instructors Kalsey Larson and Brandon Griffin lead active, h Register Today! Get FIT!! Programs that bring you and your loved ones together to improve your health and well-being! Classes designed for couples and families!