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Step 1 – Fill Out Parent/Guardian Information (One Per Family) Parent/Guardian (Print Name) Email Day Phone Evening Phone Address City Zip Code Emergency Contact (Print Name) Emergency Phone Step 2 – Fill Out Participant(s) Information First Name First Name Last Name Last Name Date Of Birth Date Of Birth Age Age Shirt Size (Circle One) YS YM YL S M L XL Shirt Size (Circle One) YS YM YL S M L XL Class Number Class Number First Name First Name Last Name Last Name Date Of Birth Date Of Birth Age Age Shirt Size (Circle One) YS YM YL S M L XL Shirt Size (Circle One) YS YM YL S M L XL Class Number Class Number Step 3 – Read And Sign The Hold Harmless And Release Of All Claims And Liability The Anaheim Community Services and its staff are committed to providing high quality programs that are safe and that will maximize the enjoyment one receives from participation. Recreation activities, by their very nature, may present circumstances that place the person(s) in or at the activity at some risk of injury. The potential of injury varies significantly depending on the type of activity and intensity of involvement. Any person wishing information on the potential of injury in any activity is encouraged to make contact with our Department at (714) 765-5191. I HEREBY AGREE TO INDEMNIFY AND HOLD HARMLESS THE CITY OF ANAHEIM, its Boards and Commissions, officers, agents, designated volunteers, or employees from any liability or claim or action for damages resulting from or in any way arising out of the participation in any City of Anaheim recreation program(s). I further understand and agree: to assume all risks inherent in the activities which are available and in which I may voluntarily participate, and understand that these activities involve risk to my person and property and to assume the risks, if any, arising from the conditions and use of equipment and facilities. I further understand that there may be risks and dangers not reasonably foreseeable at this time. In the event of injury or illness while the participant is attending City of Anaheim recreation activities, I hereby authorize the City of Anaheim to consent to medical treatment on behalf of my child as deemed necessary. The City of Anaheim Community Services Department may take and use photos of participants for publicity purposes. I hereby grant the City of Anaheim permission to publish any images taken by the City showing my child’s/children’s participation. IF THE PARTICIPANT IS A MINOR, his or her custodial parent or legal guardian must read and execute this agreement. I hereby warrant that I am the custodial parent or legal guardian of (Print All Participants Names) who is a minor, and has my permission to voluntarily participate in City of Anaheim recreation activities. I CERTIFY THAT I HAVE READ AND UNDERSTAND THIS WAIVER AND RELEASE AS IT APPLIES TO MYSELF AND TO ANY MINORS FOR WHOM I AM SIGNING. (Parent or guardian must sign for participants under 18 years of age) Date: Received By: Signature (Parent/Guardian) Staff Initials The Anaheim Community Services Department complies with the Americans with Disabilities Act. Please call (714) 765-4425 if special accommodations are needed. Anaheim Community Services Youth Sports Registration & Hold Harmless