Mundelein Park District Program Guide online special summer brochure 2020 | Page 13

CREDIT CARD PAYMENT INFORMATION
Please charge to: ❏ MC ❏ Visa ❏ DC ❏ AMEX
Card #
exp. — — / — — security code on back — — —
Name on card Amount

Signature
Credit card information supplied will be used with current registration form only and will be destroyed after registration is processed.
REGISTRATION WAIVER & RELEASE
IMPORTANT INFORMATION (Please read and sign)
The Mundelein Park & Recreation District (MPRD) is committed
to conducting its recreation programs and activities in a safe
manner and holds the safety of participants in high regard.
MPRD continually strives to reduce such risks and insists that all
participants follow safety rules and instructions that are designed
to protect participants’ safety. However, participants and parents/
guardians of minors registering for the below listed programs/
activities must recognize that there is an inherent risk of injury
when choosing to participate in recreational activities/programs.
You are solely responsible for determining if you or your minor
child/ward are physically fit and/or skilled for the activities
contemplated by this agreement. It is always advisable, especially
if the participant is pregnant, disabled in any way or recently
suffered an illness, injury or impairment, to consult a physician
before undertaking any physical activity.
WARNING OF RISK
Recreational activities are intended to challenge and engage the
physical, mental and emotional resources of each participant.
Despite careful and proper preparation, instruction, medical
advice, conditioning and equipment, there is still a risk of
serious injury when participating in any recreational activity.
Understandably, not all hazards and dangers can be foreseen.
Depending on the particular activity, participants must understand
that certain risks, dangers and injuries due to inclement weather,
slips and falls, poor skill level or conditioning, carelessness,
horseplay, unsportsmanlike conduct, premises’ defects, inadequate
or defective equipment, inadequate supervision, instruction or
officiating, and all other circumstances inherent to indoor and
outdoor recreational activities exist. In this regard, it must be
recognized that it is impossible for MPRD to guarantee absolute
safety.
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 the identified 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 these
programs/activities (including transportation services and vehicle
operations, when provided).
I recognize and acknowledge that there are certain risks of
physical injury to participants in these programs, 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 my minor child/ward or I may have (or
accrue to me or my child/ward) as a result of participating in this
program/activity against MPRD, including its officials, agents,
volunteers and employees.
I have read and fully understand the above important information,
warning of risk, assumption of risk and waiver and release of
all claims. If registering online or via fax, my online or facsimile
signature shall substitute for and have the same legal effect as an
original form signature.
Participant's name:
Participant's signature:
Date:
Parent or Legal Guardian MUST sign if participant is under age 18: