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FALMOUTH RECREATION DEPARTMENT AFTER SCHOOL PROGRAM |
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| The Falmouth Recreation Department is offering a free after school program for students at Morse Pond School. Recreation staff will walk the children to the Gus Canty Center from the Morse Pond School (There is a path from the back of the school that leads to Dillingham Ave. onto Fuller Field behind the Canty Center) but a parent must pick up their child at the Canty Center by 5 p.m. | ||||||
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The next program will run on Thursday afternoons. Beginning April 3rd and ending on April 24th |
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| Please fill out the following information and return this form to the Gus Canty Center. Registration is required for this FREE program. Each program is limited to 40 students. | ||||||
| Child's name: ______________________________________________________ Grade: ______ | ||||||
| Address: ________________________________________ City: _____________________ State: ___ Zip: ________ | ||||||
| Home phone: ___________________ Work phone: ___________________ Cell phone: ___________________ | ||||||
| List any conditions, medications or other special needs the staff should know about, for example: diabetes, asthma, or allergies. | ||||||
| _________________________________________________________________________________________________ | ||||||
| Please check the program you want to register for: | ||||||
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CONSENT AND RELEASE FORM |
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| I, the undersigned _____________________________("parent") of ______________________("my child"), a minor, do hereby consent to my child's participation in voluntary athletic programs of the Falmouth Recreation Department. | ||||||
| I also agree to
forever release the town of Falmouth, the Falmouth Recreation Department,
and all their employees, agents, board members, volunteers, and any and
all individuals and organizations assisting or participating in voluntary
athletic programs of the Falmouth Recreation Department (the "Releasees)
from any and all claims , rights of action and causes of action that may
have arisen in the past, or may arise in the future, directly or
indirectly, from personal injuries to my child or property damage
resulting from my child's participation in the Falmouth Recreation
Department's voluntary athletic programs. I agree that pictures and videos
may be used for future promotional purposes.
I also promise to indemnify, defend, and hold harmless the Releasees against any and all legal claims and proceedings of any description that may have been asserted in the past or may be asserted in the future, directly or indirectly, arising from personal injuries to my child or property damage resulting from my child's participation in the Falmouth Recreation Department's voluntary athletic programs. The Recreation Department reserves the right to deny admittance and/or suspend program privileges without reimbursement. I further affirm that I have read this Consent and Release form and that I understand the contents of this form. I understand that my child's participation in these programs is voluntary and that my child and I are free to choose not to participate in said programs. By signing this form, I affirm that I have decided to allow my child to participate in the Falmouth Recreation Department's athletic programs with full knowledge that the Releasees will not be liable to anyone for personal injuries and property damage my child or I may suffer in voluntary recreational athletic programs. |
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| Date: _____________________ Signature: ___________________________________________ |