b'17 registration formFun, its in our Natu re!InstructionsSee p 2 for registration schedule, options and refund policySee p 44 for complete instructionsPre-registration is required for all activities except where notedActivities are filled according to registration dateRegister earlyHelp us avoid the cancellation of programsMail 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 APRC ACTIVITY, YOU MUST SIGN A CURRENT YEAR LIABILITY WAIVER. ONLY ONE LIABILITY WAIVER PER CALENDAR YEAR IS NEEDED.Liability Waiver(required)Name of Participant__________________________________________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 following provisions shall apply to that participation and agree to be fully bound by them. I understand that participation in the Ashland Parks and Recreation Commission (APRC) recreational activity involves risk of injury or death. Participant is not affected by any physical condition or disability that would make participation unsafe. I understand that APRC will not provide medical treatment, and I authorize APRC to arrange for any necessary transportation in the event of an accident or emergency.For myself, my heirs, assigns or anyone who might claim on my behalf, I voluntarily assume all risks of participating in this activity and I waive, release and forever discharge any claim against APRC, its officers, agents and employees against any claim, loss, liability or expense, including attorneys fees, that may directly or indirectly result from participation in this activity, even though that liability may arise out of the negligence or carelessness of the persons or parties named in this waiver and release.Signature (required) ___________________________________ _of Participant or Parent/Guardian if under 18 years of ageDate ____________________________________________________'