Clone of 2022 Youth Program Registration

Bring your preschool aged children for fun, free play time! Let them blow off steam during the colder months inside. Bring clean indoor footwear.

Thursdays from 10am-11:30am, except for school holidays and closures. 2025/2026 year dates: October 9, 2025 through April 2, 2026.

For ages 0-5. Located at the Sexsmith Civic Centre 9917 99 Avenue.

No cost, its free to drop in any week we're open. Please don't attend if your child(ren) are feeling unwell.

Register once and drop in any week!

Parent Name*

First NameLast Name

Address*

Home Address

City

Postal Code

Parent/Guardian Name*

First NameLast Name

Please add your child(ren)'s name and age that will be attending with you. *

First NameAge

Please add additional children attending with you.

First NameAge

Please add additional children attending with you.

First NameAge

Please add additional children attending with you.

First NameAge

Best Contact Number*

E-mail*

example@example.com

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Alternate Phone Number

Does the child have any allergies, chronic illness, or medical conditions? Do they need to carry medication? If yes, please describe.

In consideration of being allowed to participate in any way in the Town of Sexsmith youth program (hereby referred to as “the Program”), related events and activities, the undersigned acknowledges, appreciates, and agrees that:

I hereby freely accept all of the risks (known and unknown) however caused associated with participation in the Program, whether the risks result in personal injury, property damage, death or some other harm to me.

I willingly agree to comply with the stated and customary terms and conditions for participation. If however, I observe any unusual or significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately.

As a condition of the Municipality allowing me to participate in the Program, I (for myself and on behalf of my heirs, next of kin, and personal representatives) agree to waive all claims that I have or may have in the future against the Municipality, its officers, officials, agents and/or employees, other participants, and sponsoring agencies/advertisers for any injury, property damage, financial loss, or any other loss that may result directly or indirectly from my participation in the Program, no matter how this loss is caused (including negligence on the part of the Municipality).

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

We are seeking your permission for the child's image to be taken and used as a visual that may be incorporated into publications, advertisements, audio-visual presentations and/or Web pages, produced for the purpose of promotion of The Town of Sexsmith programs and services. Your child's name will not be released with the publication of any images.*

YesNo

Medical Release and Authorization As Parent and/or Guardian of the named child, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor treatment for the named child. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to the Town of Sexsmith and its affiliates including Employees, Volunteers and Contractors, to provide the needed emergency treatment prior to the child’s admission to the medical facility. Release authorized on the dates and/or duration of the registered season. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

PreK Playtime Program Registration

Photo Release