Home / Cell Phone:
Emergency Phone:
Required
$
Please read this form carefully and be aware that in signing up and participating in this program(s), you will be waiving and releasing all claims for injuries you might sustain
arising out of this program. As a participant in the program(s), I recognize and acknowledge that there are certain risks of physical injury and I agree to assume the full risk of
injuries, damages or loss which I may sustain as a result of participating in any and all activities with or associated with such program(s). I agree to waive and relinquish all
claims that I may have as a result of participating in the program(s) against the Des Plaines Park District (DPPD) and its officers, agents, servants and employees. I do hereby
release and discharge the DPPD and its officers, agents, servants, and employees from any and all claims from injuries, damage, or loss which may accrue to me on account of
my participation in the program(s), including transportation services and vehicle operations, when provided. I further agree to indemnify and hold harmless and defend the
DPPD and its officers, agents, servants, and employees from any and all claims resulting from injuries, damages, and losses sustained by me and arising out of, connected with,
or in any way associated with the activities of the program(s). I agree to the terms of the District Photo/Video Policy. I have read and fully understand the above Program
Details and Waiver and Release of all Claims. Participant(s) or their legal guardian must sign this Waiver. The District will consider a facsimile signature as original.