Class Registration Form

City of San Clemente

Instructions

Print this web page using your browser.
Fill in the blanks below. Please print.
Sign the Release Agreement at the end.
Fill out the credit card information or make check payable to 'City of San Clemente'.
Print a copy of the class description from the corresponding web page for your future reference.
Choose one of the following:

Mail In

Mail registration to:

City of San Clemente
Recreation Division
100 N. Calle Seville
San Clemente, CA 92672

Mail-In registration will close four working days before the first class date.

24-Hour Drop-Off

Place registration form and check in sealed envelope and place in mail slot located on the Seville side of the Community Center, at 100 N. Calle Seville, to the right of the entrance doors.

Drop off registration will close one working day before the first class date.

Phone-In Charge

Phone-in registration taken Monday - Thursday and alternating Fridays from 9 a.m. to 4 p.m. When calling please have your Visa or Mastercard information ready.

A $1 mailing fee is added to phone-in registration.

Phone-In registration will close one working day before the first meeting date.

Assume you have been accepted into the class, program, or trip unless advised otherwise. Use your canceled check for a receipt. If you require a receipt, please mail in a self-addressed, stamped envelope with your registration form.

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

Address:  ____________________________________________________________

City: ____________________________________________  ZIP: _____________

                              Phone Numbers

Day:(  )____-_____     Night:(  )____-_____     Emergency:(  )____-_____

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 |
=======|===============|========================|===============|=====|=====
                                                                      |
                                  Credit card fee ($1), if applicable:|_____
                                                                      |
                                                            Total Fee:|_____

* Non-residents of San Clemente need to add a $3 non-resident fee for each class enrollment

Check # __________

or

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

Charge Authorization Signature: ________________________

Release and Waiver of Liability and Indemnity Agreement

The undersigned hereby releases the City of San Clemente and its officers, agents and employees from all liability to the undersigned (and from any minor participants for whom the undersigned has the capacity to contract), thereby releasing, indemnifying, and holding harmless the City of San Clemente, its officers, agents, and employees from all liability to the undersigned (and said minors) for any loss or damage on account of physical, mental and emotional injury to the undersigned (or said minors) caused by the negligence of the City of San Clemente, its officers, agents and employees. The undersigned hereby assumes full responsibility for, and the risk of, physical, mental and emotional injury due to the negligence of the City of San Clemente, its officers, agents and employees. The undersigned recognizes for himself or herself, and any minors, that the events and occurrences to which this release applies can be dangerous and as a result of signing below, the undersigned is accepting those risks for himself or herself, and for any minor participants for whom the undersigned can contract.

The undersigned hereby represents that he or she understands and is familiar with the nature of the activities in which the undersigned, and/or any minor, will participate in the San Clemente Recreation Program.

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)

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