Sugar Grove Sugar Grove Sugar Grove Sugar Grove Park District ...

Need another form Download one from our website: sgparks.org
Last Name _________________________________________ First ____________________________ Home Phone (____)_____________________
(Parent/Legal Guardian)
Street Address ___________________________________ Email_______________________________ Work Phone (____)_____________________
City ____________________________________ State _____________ Zip _______________ Cell Phone (____ )____________________
Last Name First Sex F/M Date of Birth Age Grade Program Name Session Program Fee
Our athletic leagues depend on our volunteer coaches. If interested please complete the following information:
Name:_____________________________________________________________________ (Circle One) Head Coach OR Assistant Coach
Athletic League/Sport: _______________________________________________________ Age Group/Grade: _________________________
No refunds after registration deadline on programs, uniforms, or once teams are formed. Refunds requested before registration deadline are subject to a $10 minimum service charge. A 75% refund may
be issued for athletic team participants (less costs) if replacement player is found. Activities will be cancelled if minimum registrations are not met by registration deadline. Full refunds are issued if the
Park District cancels a program. Mail this form along with your payment to Sugar Grove Park District, 61 Main Street, Sugar Grove, IL 60554. Drop box available for your
convenience 24 hours a day. Credit card payments may be faxed to 630-466-8675.
Total Due: _______________ Cash ______ Check ______ ______ ______
Credit Card # _________________________________________ Exp. Date ____/____/____ 3 Digit Security Code from Back __________
Print Cardholder Name: ____________________________________ Signature: ________________________________________
The Sugar Grove Park District does its best to accommodate those individuals with special needs. If you need any special assistance with a program, please call the office at
630-466-7436 and we will do our best to assist you.
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 programs listed above 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 (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 injuries, damages or loss, regardless of severity, that my minor
child/ward may have (or accrue to me or my child/ward) as a result of participating in these programs against the Sugar Grove Park District, including its officials, agents, volunteers and employees.
I have read and fully understand the enclosed important information, warning of risk, assumption of risk and waiver and release of all claims. Participation will be denied if the signature of adult participant OR
Parent/Guardian and date are not on this waiver
Print Participant’s Name Participant’s Signature (18 years or older OR Parent/Guardian) Date