SKOKIE PARK DISTRICT REGISTRATIONParent/Adult Name 1Parent/Adult Name 2Address Apt. #PAYMENT INFORMATIONCash Check #City/State/ZipHome Phone Work PhoneEmail AddressCredit Card (Circle One) Visa Mastercard DiscoverName on CardEmergency Contact NameAddress Apt. #City/State/ZipHome Phone Work PhoneCard # CW/CVC #Expiration Date / Amount of PaymentAuthorized SignaturePlease indicate second choice programs or classes with a check ( ).Participant's Name (Last name, first name) SexBirthdatemm/dd/yy2ndChoiceProgram Name Program Number — Section FeeSUBTOTALThe <strong>Skokie</strong> <strong>Park</strong> <strong>District</strong> welcomes individuals with disabilities into programs.Please describe any accommodations needed for successful inclusion in the program(s).LESS DISCOUNTGRAND TOTALRelease and hold harmless agreement: Participants 18 years of age or older and parents of participants under the age of 18 should read this form carefully and be aware that in signing up and participating in this program you will be waiving and releasing all claims for injuries or damages you mightpersonally sustain which might arise out of this program. As a participant in this program (or as a parent of a minor participant), I recognize and acknowledge that there are certain risks of physical injury associated with such participation, and I agree to assume the full risk for any injuries, damages, or losswhich I may sustain as a result of participating (or of my minor child’s participation) in such program as against the <strong>Skokie</strong> <strong>Park</strong> <strong>District</strong>, its officers, agents, servants, and employees. I do hereby fully release and discharge the <strong>Skokie</strong> <strong>Park</strong> <strong>District</strong> and its officers, agents, servants, and employees from any andall claims from injuries, damages, or loss which I may have or which may accrue to me on account of my participation (or on account of my minor child’s participation) in the program. I further agree to indemnify, hold harmless, and defend the <strong>Skokie</strong> <strong>Park</strong> <strong>District</strong>, its officers, agents, servants and employeesfrom 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, including transportation services when provided (or my minor child’s participation in the program). I have read and fullyunderstand this Release and Hold Harmless Agreement and any program details provided to me. It is mutually understood that the facsimile registration document (including waiver and release of all claims) shall substitute for and have the same legal effect as the original form..Participant's Signature/Date Parent/Guardian Signature (if participant Is under 18)/Date<strong>Skokie</strong> <strong>Park</strong> <strong>District</strong> • 9300 Weber <strong>Park</strong> Place • <strong>Skokie</strong>, IL 60077 • Fax: (847) 763-2025
December 15 • December 22WebTrac Online RegistrationLog onto <strong>Skokie</strong>parks.org and register for almost any course. WebTrac residentregistration begins at 8:30 a.m.. on 12/15. WebTrac non-resident registrationbegins at 8:30 a.m.. on 12/22. Go to www.<strong>Skokie</strong>parks.org and click the ‘Registerand Search for Programs’ button.Please be aware that as a first time customer you may register online only afteryou have established a household account. If you choose to request an accountonline, it will be processed the next business day and will be initially charged atnon-resident rates. Your residency status will be changed, and a refund given,when you show proof of <strong>Skokie</strong> residency at any <strong>Skokie</strong> <strong>Park</strong> <strong>District</strong> facility.Mail-In and Fax RegistrationResident mail-in and fax registration is processed randomly starting 12/16.Non-resident mail-in and fax registration is processed randomly starting 12/23.Complete and sign your program registration form (see adjacent page). Includeproof of residency and payment (check or credit card). Checks should be madepayable to <strong>Skokie</strong> <strong>Park</strong> <strong>District</strong>. Visa, MasterCard and Discover are accepted.Enrollment will be confirmed with a mailed receipt. Mail to: <strong>Skokie</strong> <strong>Park</strong> <strong>District</strong>Registration, 9300 Weber <strong>Park</strong> Place, <strong>Skokie</strong>, IL 60077. Fax to: (847) 763-2025.<strong>Winter</strong> RegistrationWalk-In RegistrationResident walk-in registration is processed at <strong>District</strong> facilities startingon 12/15 at 8:30 a.m. Non-resident walk-in registration is processed starting on12/22 at 8:30 a.m. Enrollment will be confirmed with a receipt. A legal guardianmust sign for individuals younger than 18 years.Refund Policy• For all activities, passes and memberships, you will be given a pro-rated refundwhen your request is presented in person to a costumer service representative.• Childcare (Preschool, Tot Learning Center, and SPACE) changes,cancellations, or deposit refunds must be presented to the Program Supervisor.• Trips are eligible for a refund up to seven-days prior to the event unless otherwisestated in the program description. Tickets are not eligible for refunds.• In order to process your request, we ask you to complete a request form andpresent it to a Customer Service Representative. Any credit due from a refundwill be first applied to any household balance that exists. If money is due backto you, a refund check will be mailed to you. All refund checks are processedwithin two business days of receipt of the original request.For district registration policies go to: <strong>Skokie</strong>parks.org/RegistrationPolicies.pdf<strong>Skokie</strong> <strong>Park</strong> <strong>District</strong> ContactsAdministrative Team.................................... (847) 674-1500, ext. 2100Mark Schneiderman, CPRP .........................................Executive DirectorJohn Ohrlund, CPRP.....................Superintendent of <strong>Park</strong>s and FacilitiesWilliam Schmidt, CPA..................... Superintendent of Business ServicesMichelle Tuft, CPRP...................................Superintendent of RecreationBusiness Services..................................................................ext. 2100Sonia Cannon........................................................Accounts Payable ClerkFred Colón............................Systems & Infrastructure Support SpecialistDavid Hunt............................................................Network AdministratorVilma Matos..................................................Payroll/Registrar SupervisorAnn Perez.................................................................... Executive SecretaryNancy Portillo..............................................Senior Accounting SupervisorLynn Seebacher..............................................Human Resources ManagerDammrich Rowing Center................................................... ext. 2200Scott Runkle.....................................................................Facility ManagerDevonshire Cultural Center................................................. ext. 2400Robin Horwitz, CPRP.....................................................Facility ManagerKathy Day..................................................... Customer Service SupervisorHeidi Luksa............................................................... Preschool SupervisorCaryn Watson, APRP.........................................Cultural Arts SupervisorEmily Oaks Nature Center................................................... ext. 2500Lee Hansen.......................................................................Facility ManagerJill Flaherty........................................... School-Age Program CoordinatorAnastasia Steinbrunner...................... Tot & Family Program CoordinatorOakton Community Center & Aquatics. ext. 2700Crystal VanHyning, CPRP..............................................Facility ManagerLisa Boldt, CPRP....................................Senior Adult & Teen SupervisorNancy Eschker, CPRP............................School-Age Program SupervisorMary Grear.........................................................Exploritorium SupervisorDave Putziger..............................................Assistant Aquatics SupervisorScott Runkle................................................ Aquatics & Safety SupervisorPamela Zeid, CPRP .................................... Customer Service Supervisor<strong>Park</strong> Services........................................................................ ext. 2800Mike Rea, CPRP.................................. Assistant Superintendent of <strong>Park</strong>sSteve Ames...............................................................Landscape SupervisorJohn Gacki........................................................................ <strong>Park</strong>s SupervisorJeff Hacker...............................................................Operations SupervisorDima Kirland, CPRP.................................. <strong>Park</strong> Services Office ManagerSkatium Ice Arena................................................................ ext. 2900Frank Gallagher................................................................Facility ManagerSteve Glickman............................................................. Hockey SupervisorClinton Hieber............................................................ Assistant SupervisorIris Levin............................................. Customer Service/Office AssistantKerry Murphy....................................................Figure Skating Supervisor<strong>Skokie</strong> Heritage Museum..................................................... ext. 3000Amanda Hanson, CPRP..................................................Facility Manager<strong>Skokie</strong> Sports <strong>Park</strong>................................................................ext. 3100Weber <strong>Park</strong> Golf Course....................................................... ext. 3600Richard Lee.......................................................Golf Operations ManagerMichael Lucchese........................................................ Head GreenskeeperChris Pytell............................................................ PGA Golf ProfessionalTot Learning Center............................................................. ext. 3400Fouzia Khan....................................................Childcare Services ManagerWeber Leisure Center........................................................... ext. 3500Jon Marquardt, CPRP......................................................Facility ManagerBob DeLeonardis........................................................ Athletics SupervisorSarah Natalie, CPRP...............................Fitness First! Assistant ManagerKim Reynolds............................................... Customer Service SupervisorSayeeda Khan...................................................... Sponsorship CoordinatorProgram Guide Designed and Edited by:Jim Bottorff............................. Communications and Marketing ManagerRachel Pozner...................................................................... Graphic ArtistScott Walker........................................................................ Graphic Artist<strong>Winter</strong> 2011-12| 65
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