Last Name:

First Name:

Child's Name:

Child's Birth Date:

Street Address:

City:

State:

Zip Code:

Home Phone:

Work Phone:

Email Address:

Center Your Child Will Be Attending?
CITY PARK COMMUNITY CENTER FAIRMONT COMMUNITY CENTER

Liability Waiver

I, we the parent's of the above named male or female, here by give my/our approval for his/her participation in the above
named activity during the current season. I/we assume all risks and hazards incidental to the conduct of the activities and
transportation to and from activities. In case of injury to participant, I/we do further release, absolve, indemnify, and
hold harmless the Spalding County Recreation Department, and organizers of the activity, sponsors, the supervisors, the
recreation director, and/or all of them from any injury sustained in the play and any activity engaged upon the grounds and/or facilities of the Spalding County Recreation Department.

I/we further understand that, unless otherwise stated, Spalding County Recreation department does not carry accident insurance on any athletic event sponsored by the recreation department. Insurance is the sole responsibility of each individual that participates.

I accept I Decline