Pine Bluff Parks and Recreation Registration

Pine Bluff Parks and Recreation Registration

Register to participate in Pine Bluff Parks and Recreation programs.
Parent or Guardian Name

First NameLast Name
Participant's Name

First NameLast Name
Participant Date of Birth

MonthDayYear
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Race
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Please list any allergies or medical conditions we should be aware of
Choose Your Sport
How did you hear about us?
Medical Release Waiver
I authorize Pine Bluff Parks and Recreation to provide or arrange for emergency medical care if necessary, and I agree to be financially responsible for all associated costs. RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT (For Pine Bluff Parks and Recreation) PLEASE READ CAREFULLY BEFORE SIGNING - THIS IS A LEGAL DOCUMENT THAT AFFECTS YOUR RIGHTS
Release of Liability Waiver
In consideration for being permitted to use the Pine Bluff Parks and Recreation facility and participate in activities, I hereby: Release and forever discharge Pine Bluff Parks and Recreation facility, its owners, managers, employees, volunteers and agents from any and all claims, demands, damages or causes of action arising out of or related to my use of the facility or participation in activities. – Waive any and all claims I may have against the above parties for any injury, loss or damage, including those caused by negligence, to the fullest extent allowed by law. I agree to indemnify and hold harmless Pine Bluff Parks and Recreation and its representatives from any and all liability, claims, damages, costs, or expenses (including legal fees) arising from my participation in facility activities, including any claims brought by third parties.
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