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Parks & Recreation Registration Form Please send to Murray Parks & Recreation, PO Box 57520, Murray UT 84157-0520 www.murray.utah.gov One person per sign-up form Program Registering For: Child’s Name Address City, Zip Code Home Phone Birth date Age Grade Male or Female School Father’s Name W ork Phone Cellular Phone Birth date Mother’s Name W ork Phone Cellular Phone Birth date Email Address W ould you or a member of your family be willing to coach? Coach Assist. Coach Yes____ Yes____ Does your child have any physical Limitations? Yes____ Explain: Special request of one Friend/School/Coach We do not guarantee your request. However, we will make every attempt to try! Liability release and permission to participate In consideration of the acceptance of my application for the above activity, I hereby waive, release, and discharge any all claims for damages, for death, personal injury, or property damage which my child may have, or which may hereafter accrue as a result of participation in said event. It is understood that some recreational activities involve an element or risk or danger of accidents, and knowing those risks, I hereby assume those risks. It is further understood and agreed that this waiver, release, and assumption of risk is to be binding on my heirs and assigns. I have read and understood the foregoing registration, liability release, and consent to treat form and agree to all of their terms and conditions. Parent’s Signature Date Office Use Only: ___Check ____Cash ____Credit Card Payment_________