b'15 registration infoPre-registration at ashland.or.us/register required for all programs unless otherwise indicatedInstructions See p 2 for registration schedule, options and refund policy See p 44 for complete instructions Pre-registration is required for all activities except where noted Activities are filled according to registration dateRegister earlyHelp us avoid the cancellation of programs Mail or bring your completed Registration Form with payment to: APRC (Ashland Parks & Recreation Commission)at The Grove, 1195 E Main St, Ashland, OR 97520Date of Birth ________________Participants Name ________________________________________________________________________ M F(mmddyyyy)Parents/Guardians Name (if under 18) _________________________________________________________________________________Residential Address ____________________________________________________________________________________________________City ________________________________________________________ State _________________________Zip ________________________Phone Numbers:Home___________________________________ Work ________________________ Cell ________________________E-Mail Address________________________________________________________________________________________________________Your email address is only used to provide you with instant confirmation and a printable receiptEmergency Contact Name ________________________________________________________________ Phone ________________________Activity/Session/DatesAmount_______________________________________________________________________________________________________$ ______________________________________________________________________________________________________________________$ _______________Cash_______________Make checks payable to: APRC Check#_____________ Total $ _______________Credit Card Number____________________________________________________________________(circle one)VISA M/C AMEXName on Card (print)_________________________________Exp Date_______________ _______3-Digit Security Code(on back of card)______Signature _________________________________________________________________________________ Date _______________________Please Note: PRIOR TO ENROLLMENT IN ANY Ashland Parks & Recreation ACTIVITY, YOU MUST SIGN A CURRENT YEAR LIABILITY WAIVER. ONLY ONE LIABILITY WAIVER PER CALENDAR YEAR IS NEEDED.Liability Waiver(required)Name of Participant__________________________________________________ get fresh with the locals!I hereby certify that I am 18 years of age or older. If I am the parent or legal guardian of a participant who is under 18 years of age, I agree that the followingASHLAND TUESDAY MARKET INDOORWINTER TUESDAY MARKETAshland Armory, 1420 E. Main Street Phoenix Civic Center, 220 N. Main Street, Phoenix ORprovisions shall apply to that participation and agree to be fully bound by them.8:30AM -1:30PM March 3 - November 24 10:00AM -2:00PM - Until February 25 I understand that participation in the Ashland Parks & Recreation Commission ASHLAND SATURDAY MARKET MEDFORD THURSDAY MARKET (APRC) recreational activity involves risk of injury or death. Participant is notDowntown Ashland, Oak Street Hawthorne Park, Corner of Hawthorne & E. Jacksonaffected by any physical condition or disability that would make participation8:30AM -1:00PM May 2 - October 31 C R AFTED8:30AM -1:30PM March 5 - November 19unsafe. I understand that APRC will not provide medical treatment, and I| LOCALLY- S O UD - Rauthorize APRC to arrange for any necessary transportation in the event of anA N CEH D | | accident or emergency. L RA ARIUNTFor myself, my heirs, assigns or anyone who might claim on my behalf,L &U SCI HIvoluntarilyassumeallrisksofparticipatinginthisactivityandIwaive,R N IGA E|release and forever discharge any claim against APRC, its officers, agents and |W MWemployees against any claim, loss, liability or expense, including attorneysW. RVGROWE T. C ORKEfees, that may directly or indirectly result from participation in this activity,RSMAeven though that liability may arise out of the negligence or carelessness of the persons or parties named in this waiver and release.Signature (required) ___________________________________Cultivating Communityof Participant or Parent/Guardian if under 18 years of age Named 10 of the Best Farmers Markets in the U.S.ALL YEAR LONGDate ____________________________________________________ For More Market Information Visit Us @ www.rvgrowersmarket.com'