After School Program Enrollment Form

Lassen County Day of Play: Feb. 22 Registration

Lassen County Fairgrounds, February 22, Noon to 6 pm.
The Lassen County Day of Play brings together youth, families, and community support through shared experiences of speakers, activities, recreation, and fun. Participants engage in workshops that provide resources, life skills training, and tools for overcoming barriers to success. This event inspires individuals to embrace new ideas and opportunities.

The Day of Play is a Multi-agency collaborative that aims to bring families together to have fun and grow together in a safe, fun, and supportive environment. All families are welcome to attend the event.

Please complete and submit one form per family that would like to register for this first Lassen County Day of Play.
Parent/ Guardian Name*

First NameLast Name
Additional Parent/ Guardian Name:

First NameLast Name
Parent/ Guardian Phone Number*

Area CodePhone Number
Additional Parent/Guardian Phone Number:

Area CodePhone Number
Parent/ Guardian Email*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
My family is in need of assistance with transportation to and from the event

YesNo
Parent/ Guardian T-shirt Size
Additional Parent/ Guardian T-shirt Size
Student's Name*

First NameLast Name
Student Birthdate

MonthDayYear
Date
Students School
Grade in School( Fall 2024)
T-shirt Size
Students Gender
Student's Name

First NameLast Name
Student Birthdate

MonthDayYear
Date
Students School
Grade in School( Fall 2024)
T-shirt Size
Students Gender
Student's Name

First NameLast Name
Student Birthdate

MonthDayYear
Date
Students School
Grade in School( Fall 2024)
T-shirt Size
Students Gender
Student's Name

First NameLast Name
Student Birthdate

MonthDayYear
Date
Students School
Grade in School( Fall 2024)
T-shirt Size
Students Gender
I understand that the Lassen County Day of Play will be held on Saturday, February 22, 2025 at the Lassen County Fairgrounds.*

YesNo
Please note any known allergies:

Day of Play Rules and Expectations
THE GOLDEN RULE: Be respectful to the speakers, adults, staff, and others.

SMOKING POLICY: Any person over the age of 21 years of age may smoke tobacco ONLY in the designated smoking area. Underage smoking and smoking outside the designated smoking area is prohibited.

FIGHTING POLICY: Fighting will NOT be tolerated under any circumstances. Anyone who engages in fighting, including provoking or initiating a fight, will be asked to leave.

CONDUCT DURING PRESENTATIONS/WORKSHOPS: All participants will be respectful during all speakers and workshops. Participants will NOT be on their phones or talking during presentations.

FRATERNIZING: There will be NO inappropriate touching, excessive PDA, or couples sneaking off together at any time during the event.

Drugs: All alcohol, marijuana products and illegal substances are strictly PROHIBITED.

All minors in attendance must come with a responsible adult who will be able to supervise them.

I have read, understood, and agree to abide by the rules listed above. I realize that breaking any of these rules will result in a consequence, and I may be asked to leave the event.
Signature*

Clear

I understand that if my child has had a fever over the last 24 hours or has been vomiting during that time they are not eligible to attend the event.*

Agree
I understand that reasonable measures will be taken to safeguard the health and safety of all participants and that I will be notified as soon as possible in the event of an emergency. In the event of an emergency if I can not be reached I hereby authorize transportation to a medical facility at my expense to provide the necessary medical treatment of my child.*

AgreeOther

Liability Release
LIABILITY RELEASE

(SIGNED BY PARENT OR GUARDIAN IF PARTICIPANT IS UNDER 18)

I understand that parts of the Lassen County Day of Play may be physically or emotionally demanding and can cause injury. I affirm that my health is good and that I am not under a physician's care for any undisclosed condition that affects my fitness to participate. I understand that each participant must assume the risk of physical injury that could result from these activities.

I ALSO UNDERSTAND THAT PARTICIPATION IS ENTIRELY VOLUNTARY. I ENTER INTO THIS ADVENTURE AND TAKE FULL RESPONSIBILITY FOR ANY DECISION TO PARTICIPATE OR NOT TO PARTICIPATE AND AGREE TO FOLLOW ALL SAFETY INSTRUCTIONS. WITH MY SIGNATURE BELOW, I RELEASE ALL AGENCIES THAT HOST THE YES EVENT FROM ALL LIABILITY FOR ANY INJURY TO ME OR MY CHILD FROM PARTICIPATING IN THESE ACTIVITIES.

PUBLICITY RELEASE

I hereby permit staff to take pictures and use a photograph(s) of the participant named above for publicity purposes.
Signature*

Clear
Date Signed*

MonthDayYear
Date
Should be Empty:

Lassen County Day of Play: Feb. 22 Registration

Day of Play Rules and Expectations

Liability Release