Village of Lewiston Recreation Fitness Center Registration Form

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Village of Lewiston Recreation Address: 145 N. 4th Street, Lewiston, NY 14092
Contact us at (716) 754-1990 or recreation@villageoflewiston.com

Fitness Center Hours:
Monday-Friday 3-8pm
Saturdays 9am-1pm

RELEASE OF LIABILITY
In consideration of permitting myself or the below-named child to participate in games, practices, and other activities of the Village of Lewiston Recreation Department, I, the undersigned as myself, parent or guardian of said minor, do hereby release and agree to hold harmless the Village of Lewiston Recreation Department and its said agents, employees, coaches and volunteers from any liability for bodily injury, personal injury or property damage which may occur to myself or said minor on the part of said program or its agents, employees, coaches and volunteers related to this program.

Email *

First Name *

Last Name *

Street Address *

Town *

Zip *

Phone Number *

Date of Birth *

YYYY

Emergency Contact Name *

Emergency Contact Phone Number *

Relation to Emergency Contact

A copy of your responses will be emailed to the address you provided.

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