Ozark Community Center

Parent/Guardian Information
Parent 1:*

First NameLast Name
Cell Number*

Area CodePhone Number
Home Number

Area CodePhone Number
E-mail*
Parent 1 - address the same as child's:*

YesNo
Parent 1 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent 2:

First NameLast Name
Cell Number

Area CodePhone Number
Home Number

Area CodePhone Number
E-mail
example@example.com
Parent 2 - address the same as child's:

YesNo
Parent 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Person(s) authorized to pick child up from the Ozark Parks and Recreation Program:*

The City of Ozark Parks & Recreation Department

ASSUMPTION OF RISK & RELEASE OF LIABILITY AGREEMENT
In consideration of participating in ALL City of Ozark Parks and Recreation Department activities, regardless of location, and use of ANY of its facilities and/or properties every individual must fill out and sign this document. For participants under eighteen (18) years of age, parent(s) or guardian(s) must sign below.
Name (of individual participating, or of parent/guardian for individuals under 18 years of age)*

First NameLast Name
Birth Date*

MonthDayYear
Address (Address, City, State)*
Zip Code*
Cell Phone *

Area CodePhone Number
Home Phone

Area CodePhone Number
Email*
example@example.com
Emergency Contact*

First NameLast Name
Emergency Phone Number*

Area CodePhone Number
In consideration of access to and use of the City of Ozark Parks and Recreation Department facilities and participating in any of its activities and after carefully reading this document, I acknowledge, appreciate, and agree that:

I am at least eighteen (18) years of age and am of sound mind. I have carefully read this document and understand that it contains information regarding my responsibilities, assumptions of risk, and includes a release of liability, indemnification, and surrenders certain legal rights.

It is my responsibility to determine my physical condition, and the physical condition of any minor I am responsible for, and I acknowledge that it is safe for me and/or said minor to participate in the use of the Ozark Parks and Recreation Department facilities and activities, including, but not limited to: sports, swimming pool, rock wall, weight machines, track, trail, gymnasium, fitness classes, free weights, jump/bounce houses, etc.

I, on my own behalf and on the behalf of any minor accompanying me, agree to abide by and follow the rules, regulations, and policies of the City of Ozark Parks and Recreation Department at all times while using its facilities and/or participating in its activities.

I, on my own behalf and on the behalf of any minor accompanying me, am aware of the inherent risk of injury associated with the activities involved including the potential for permanent disability and death. It is my responsibility to consult with a physician prior to physical activity if I deem it necessary.

I, on my own behalf and on the behalf of any minor accompanying me, hereby release, hold harmless, and covenant not to sue the City of Ozark, with respect to any and all injury, disability, death, or loss or damage to person or property, whether caused by the negligence of the released party, its employees, and/or agents, or otherwise.

I, on my own behalf and on the behalf of any minor accompanying me, knowingly and freely assume all such risks of any loss, damage and injury that may occur in relation to any activity offered by City of Ozark, even if arising from the negligence of those persons released from liability herein, and I assume all responsibility for myself and any minor accompanying me.

I further agree to defend, hold harmless, and indemnify City of Ozark from any and all claims made by third parties against the City of Ozark for losses or causes of action of any kind or type, including but not limited to those for personal injury, including death, and/or property damage or loss, out of or in connection with the use of facilities operated by and/or activities organized by the City of Ozark Parks and Recreation Department by myself and/or a minor that I am responsible for.

I agree and understand that this release of liability and assumption of risk agreement covers each and every time I and/or a minor in my custody attend and/or participate in the City of Ozark Parks and Recreation facilities and activities.

I authorize the City of Ozark employees and/or staff to obtain or provide medical care for me and/or a minor in my custody and to call for and/or transport me and/or a minor in my custody to a medical facility. I authorize medical personnel to render such treatment they deem necessary for the health of me and/or a minor in my custody. I agree that the City of Ozark has no responsibility for medical care provided to me and/or a minor in my custody and I agree to pay all costs associated with such medical care and transportation.

I agree that this Agreement and all other aspects of my relationship with the City of Ozark are governed by Missouri law and venue shall be appropriate in Christian County, Missouri. Any portion of this Agreement deemed unlawful or unenforceable shall not affect the enforceability of the remaining provisions of this Agreement and the remaining provisions shall continue in full force and effect.

I have carefully read, understand and voluntarily sign this Agreement and acknowledge that it shall be effective and binding upon myself and my family and my heirs, executors, representatives and estate.
Participant Printed Name*

First NameLast Name
If on behalf of minor, name of minor:*

First NameLast Name
Child 2 - If on behalf of minor, name of minor 2:*

First NameLast Name
Child 3 - If on behalf of minor, name of minor 3:*

First NameLast Name
Child 4 - If on behalf of minor, name of minor 4:*

First NameLast Name
Child 5 - If on behalf of minor, name of minor 5:*

First NameLast Name
Signature*

Clear
As a consequence of my child's participation in the Ozark Parks Department program, I recognize that my child may be photographed or videotaped for promotional purposes or for situations such as newspaper articles, videotapes or pictures. I also recognize that that I must notify the Parks Department if I do not wish for this to be the case.*

I agreeI do not agree - I will provide in writing (digital or written) to the Recreation Supervisor my wishes to the contrary. I recognize that this checkbox does not meet the requirements outlined above.
Ozark Parks and Recreation's Cancellation Policy:
- Program fees offset the cost to plan, schedule, and staff programs. When you sign up for a program, we depend on your enrollment for that program to succeed. Please plan your schedule carefully, as we cannot accept responsibility for your personal circumstances.
- If you must cancel from the HSPE program, please submit in writing or via email a cancellation to Recreation@OzarkMissouri.com five business days prior to the start of the semester. You will not be enrolled in the following semester.
- You will be notified if a program is cancelled due to insufficient registration.
- Refunds take 2 to 3 weeks, and you must fill out a request for refund form and may be subject to a refund fee of $10.
- There will be a $25.00 fee for all returned checks.
Please acknowledge the above cancellation policy.*

I have read the above cancellation policy and acknowledge how it applies to my Home School P.E. program.
Should be Empty:

Home School PE Registration

The City of Ozark Parks & Recreation Department