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NAME (Parent or Guardian if under 18) ADDRESS HOME PHONE DAYTIME PHONE Marysville Parks & Recreation Registration Form MARYSVILLE PARKS & RECREATION REGISTRATION FORM Registration Form Per Person/Family Please print & fill out completely City State Zip TOTAL FEES: For and in consideration of the opportunity offered to participate in the above named activity offered by the Marysville Parks and Recreation Department, I, as evidenced by signature, do hereby hold harmless, re- lease and waive all claims I/my child may have against the City of Marysville, its officials, employees, agents or contracted instructors, and any other person(s) involved in the above named activity/activities for any and all injuries, losses or damages suffered by me or my child as a result of our participation in the above named activity/activities. I accept full responsibility for cost of treatment for any injury, losses or damages suffered. I grant to the City of Marysville, its representatives and employees the right to take photographs of me and my property in connection with the above-registered program. I authorize the City of Marysville, its as- signs and transferees to copyright, use and publish the same in print and/or electronically. I agree that City of Marysville may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising and Web content. I have read and understand the above: PARENT/GUARDIAN SIGNATURE (if under 18): ❑ Check # ❑ Money Order ❑ Cash (Please do not mail cash.) ❑ Visa/MasterCard Upon receipt of this Registration Form a staff member will contact you for your credit card payment information. SIGNATURE: Amount Enclosed: $ Complete Registration Form below. Make check or money order payable to: “City of Marysville”: Marysville Parks and Recreation 6915 Armar Road Marysville, WA 98270 Register in the Parks and Recreation Office located in Jennings Memorial Park. (360) 363-8400 for more details. FAX (360) 651-5089 MAIL WALK IN CALL US PARTICIPANT NAME CLASS/PROGRAM DATE(S) TIME FEE BIRTH- DATE COURSE # M/F DATE: EMAIL ONLINE Register online at Marysville ePlay: http://marysvillewa.gov ePlay ❑ Yes, I would like to receive Parks & Recreation email updates Refund Policy The Marysville Parks & Recreation Department wishes to provide you with the highest quality recreation program possible and ensure your satisfaction. If you are dissatisfied with the quality of your instructor, facility, or any other program component, please call us at (360) 363-8400, and we will be happy to address your concerns. ALL REQUESTS FOR REFUNDS MUST BE IN WRITING (Please allow 3-4 weeks for processing.) Recreational Activities 1. Participants will receive a full refund if the class is cancelled by the Parks Depart- ment. 2. Refunds requested 5 working days prior to the first class would receive a full refund, less a $10 administrative fee. Adult Team Athletics 1. Once a team’s entry fee is submitted to the Parks Department’s Athletic Office, a $25 service charge will be assessed when a team withdraws from the league prior to the scheduling process. 2. Teams requesting a refund after game schedules have been completed will be refunded, less a $150 cancellation fee. 3. Refunds will not be issued for any reason after the start of league play. 4. Refunds will be made to the person listed as head coach/manager of a team. Youth Athletics 1. Participants requesting a refund in writing prior to the team’s scheduled second practice of the season will receive a full refund. (Less $10 administrative fee.) 2. Refunds will not be issued after the second practice has taken place. 3. Injuries prohibiting continued participation in the Marysville Parks and Recreation Departments youth athletic programs are subject to pro-rated refunds. Special Events and Facility Rentals @ Jennings Park/Marysville Library 1. Participants requesting a refund in writing 10 working days in advance of the rental will be refunded, less a $10 administrative fee. 2. Refunds will not be issued if a refund request is made later than 10 days prior to rental. 3. No refunds will be given on trips or special events, unless there is someone on a wait list to fill the vacancy.