Class Registration Form

City of Fountain Valley

1. Make sure you've read the general information applicable to all classes.

2. Print this web page using your browser.

3. Fill in the blanks below. Please print.

4. Sign the Release Agreement at the end.

5. Make check payable to 'City of Fountain Valley'.

6. Print a copy of the class description from the corresponding web page for your future reference.

7. Choose one of the following:

• No registration will be taken after the second class.
• Checks or money orders only made payable to City of Fountain Valley.
• No cash accepted.
• Use your canceled check for a receipt.
• If you require a receipt, please mail in a self-addressed, stamped envelope with your registration form.
• Assume you have been accepted into the class, program, or trip unless advised otherwise.

Adult Last Name: _____________________  First: __________  M.I.: _____

Address:  ____________________________________________________________

City: ____________________________________________  ZIP: _____________

Day Phone: (   )____-______            Evening Phone: (   )____-______

Emergency Contact Person: ______________________________

Emergency Phone: (   )____-______


How did you hear about our programs?
[  ] Recreation Brochure
[  ] Newspaper
[  ] Flyer 
[  ] Word of Mouth
[  ] Online
[  ] Other ___________________________________________________________


============================================================================
Class# | Class         | Participant's          | Date of Birth | Sex | Fee
       | Name          | Full Name              | (if under 18) |     |     
=======|===============|========================|===============|=====|=====
       |               |                        |               |     |
       |               |                        |    /    /     | M/F |
=======|===============|========================|===============|=====|=====
       |               |                        |               |     |
       |               |                        |    /    /     | M/F |
=======|===============|========================|===============|=====|=====
       |               |                        |               |     |
       |               |                        |    /    /     | M/F |
=======|===============|========================|===============|=====|=====
                                                                      |
                                                            Total Fee:|_____

Check # __________

or

[ ] Visa [ ] Mastercard
#_______-_______-_______-_______ Exp.Date: ____/____

Release and Waiver of Liability

I hereby forever Release and Discharge the City of Fountain Valley, and its officers and employees, from any and all liabilities, claims, demands, or causes of action that I may hereafter have for injuries and damages arising out of participation in any City Recreation Program including, but not limited to, losses caused by th passive or active negligence of the released parties or of hidden, latent or obvious defects or dangerous conditions in any City property or property used by any City Recreation Program. This Release shall also release the Released Parties from related activities not conducted on City property, including travel and off-site activities. I understand that Recreation Activities may involve risks and dangers that no amount of care, caution, instruction or expertise can eliminate and I expressly and voluntary assume all risk of injury while participating in any City Recreation Program activity. This release shall remain in effect until revoked and shall extend to all City Recreation Program activities that participant may hereafter participate in. A copy of this Release may be used to the same extent as the original.

I, THE UNDERSIGNED, 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.

Participant Signature: ___________________________________ Date: __________
(Parent or guardian must sign for participants under 18 years of age)