2025 Summer Stroke Clinic Registration Form

Parent/Guardian Name*

Parent/Guardian Phone Number*

Please enter a valid phone number.

Home Address*

Street Address

Street Address Line 2

CityState

Zip Code

By using this form to register for the Alpena County Swim Stroke Clinic, I acknowledge that I have been provided and read the online Patron Agreement and agree to follow all the policies and procedures. I understand that failure to do so can result in removal from the facility.*

Yes

Liability Release: I, as a participant or legal guardian representing a minor participant, agree to release The County of Alpena, sponsors, and all officers, employees and volunteers from any and all liability for accidents, injuries, loss of/or damage to my/our person or property that may arise out of my/our participation in or my/our presence at listed activity. I am aware that there are certain risks or possible dangers in participating in this activity. I have entered into this agreement of my own free will. *I have read the Liability Agreement and agree to abide by the rules.*

Yes