2026 Camp and Summer Clinic / Program Registration Form
Fill out all required parts of this form carefully by completing both pages. Incomplete or inaccurate information will delay your registration. New registrants may be required to show proof of residency when registering. See the Camp Registration Info page for valid forms accepted for proof of residency. See the Camp Registration and Payment Information pages for important registration information and refund policy.
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Fill in information for head of household – please print
Parent / Guardian Name ________________________________________________________________________________________________________________________________________________ Address ______________________________________________________________________ City ____________________________________________________ Zip ______________________ Home Phone ______________________________________ Business Phone ____________________________________ Email _____________________________________________
2
Camp and Program Totals
Complete information for each participant on the other side of this form and enter the amounts. Both pages must be included in order to register all participants.
* Deposits and full payments may be paid by cash, check or credit card. If you are choosing the Camp Payment Plan option, you must provide credit card information in Section 4 for the balance due. Three installment payments will be automatically charged to your credit card on the following dates: March 16, April 16, and May 16.
Fee Deposit Balance Due( fee less deposit)
Participant # 1 totals Participant # 2 totals
TOTALS( add each column)
3
Complete payment information( make checks payable to the Glenview Park District)
Total of fees & deposit you are paying today $ _____________
Balance due $ ____________________________________________________ ___ Visa ___ MasterCard ___ Discover ___ Amex ___ Cash ___ Check ____________________________________________ Card holder( print name) Card Number __ __ __ __- __ __ __ __- __ __ __ __- __ __ __ __ Authorized Signature ______________________________________________ Exp. Date _____________ p I authorize the Glenview Park District to charge my balance due.
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Sign the Waiver PARTICIPATION WILL BE DENIED if signature of adult participant or parent / guardian and date are not on this waiver. Waiver and Release of All Claims and Assumption of Risk
Please read this form carefully and be aware that in signing up and participating, in this program / activity, you will be expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or loss which you or your minor child / ward might sustain as a result of participating in any and all activities connected with and associated with this program / activity( including transportation services / vehicle operation, when provided).
I recognize and acknowledge that there are certain risks of physical injury to participants in this program / activity, and I voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that my minor child / ward or I may sustain as a result of said participation. I further agree to waive and relinquish all claims I or my minor child / ward may have( or accrue to me or my child / ward) as a result of participating in this program / activity against the Glenview Park District, including its officials, agents, volunteers and employees( hereinafter collectively referred as“ Glenview Park District”).
I do hereby fully release and forever discharge the Glenview Park District from any and all claims for injuries, damages, or loss that my minor child / ward or I may have or which may accrue to me or my minor child / ward and arising out of, connected with, or in any way associated with this program / activity.
I understand that photos and videos are periodically taken of people participating in Glenview Park District programs and activities and I agree that any photograph or videotape taken by the park district of me or my minor child / ward while participating in a park district program or activity may be used by the park district for promotional purposes including its electronic media, videotapes, brochures, fliers and other publications without additional prior notice, permission or compensation to the participant.
I have read and fully understand the above important information, the refund, transfer and program policies, warning of risk, assumption of risk and waiver and release of all claims. If registering via fax, your facsimile signature shall substitute for and have the same legal effect as an original form signature.
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Signature of Participant or Parent( if participant is under 18 years)
Return your form to the park district: Park Center, 2400 Chestnut Ave., Glenview, IL 60026 Resident Priority Registration: 9 am, 1 / 15-1 / 19 • General Registration Begins: 9 am, 1 / 20
Date