2022 Caledonia Recreation Registration Form

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Please register ONE child at a time.

Child's First Name *

Child’s Last Name *

Grade in Fall 2022 *

Date of Birth *

YYYY

Home Address *

Home Phone *

Parents'/Guardians' Names: *

Emergency Contact Person *

Emergency Phone *

Please list first and last names of people allowed to pick up your child from Recreation *

Please list first and last names of anyone NOT ALLOWED to leave with your child

Doctor's Name *

Doctor's Phone *

Additional medical information that Recreation staff should know

Child has permission to walk/bike to/from Recreation *

Yes

Required

Caledonia Recreation often publishes information celebrating our program and the children participating in it on social media. Your child's name, photograph/video, and/or original art work is able to appear on our Facebook and/or Instagram page with your permission. Please check your preference: *

I give permission for my child's name, photograph/video and/or original artwork to be used on Caledonia Recreation's social media

I do not give permission for my child's name, photograph/video and/or original artwork to be used on Caledonia Recreation's social media

Required

I GIVE APPROVAL TO HAVE MY SON/DAUGHTER TREATED IN AN EMERGENCY ROOM OR ANY HOSPITAL FOR ANY INJURY SUSTAINED WHILE PARTICIPATING IN ACTIVITY. PLEASE TRY TO CONTACT ME FIRST. SHOULD THE HOSPITAL BE UNABLE TO REACH ME, I DO GRANT PERMISSION FOR THE HOSPITAL TO TREAT MY CHILD. I REALIZE THAT IN CASE OF ACCIDENT OR INJURY, I WILL NOT HOLD THE VILLAGE OF CALEDONIA, THE RECREATION COMMISSION, THE RECREATION DIRECTOR, OR THE RECREATION STAFF/INTERNS RESPONSIBLE. *

I AGREE TO THE ABOVE TERMS AND CONDITIONS

Required

Village of Caledonia (the “Village”) cannot prevent you or your child(ren) from becoming exposed to, contracting or spreading COVID-19 while attending Village activities (the "Camp') or being on Recreation premises. It is not possible to prevent against the presence of the disease. Therefore, if you choose to utilize Camp's services, and/or enter onto Recreation's premises you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19. ASSUMPTION OF RISK: I have read and understood the above warning concerning COVID-19. I hereby choose to accept the risk of contracting COVID-19 for myself and/or my child(ren) in order to utilize Recreation's services and enter Recreation's premises. These services are of such value to me and/or my child(ren) that I accept the risk of being exposed to, contracting, and/or spreading COVID-19 in order to utilize Recreation's services and premises in person. WAIVER OF LAWSUIT/LIABILITY: I hereby forever release and waive my right to bring suit against the Village and its agents, employees, volunteers, trustees, board members and other representatives in connection with exposure, infection and/or spread of COVID-19 related to utilizing Recreation's services and premises. I understand that this waiver means I give up my right to bring any claims including for personal injuries, death, disease or property losses, or any other loss, including but not limited to claims of negligence and give up any claim I may have to seek damages whether known or unknown, foreseen or unforeseen. I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS RELEASE, AND FREELY AND KNOWINGLY ASSUME THE RISK AND WAIVE MY RIGHTS CONCERNING LIABILITY AS DESCRIBED ABOVE. *

I AGREE TO THE ABOVE TERMS AND CONDITIONS

Required

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