Summer

Morton Grove Park District | 6834 Dempster Street | (847) 965-1200 | mortongroveparks.com Prairie View Community Center, 6834 Dempster St, Morton Grove, IL 60053 Phone: (847)965-1200 Fax: (847)965-4115 mortongroveparks.com REGISTRATION FORM FAMILY LAST NAME _____________________________________________________________________________________________________________ ADDRESS ____________________________________________ CITY ____________________________ ZIP ____________________ PRIMARY PHONE ______________________________________ DAY/CELL PHONE ___________________________________________ EMAIL ADDRESS ___________________________________________ A staff member will be in contact with you to make necessary arrangements. CODE PROGRAM NAME PARTICIPANT'S FIRST NAME GENDER M OR F BIRTH DATE MM/DD/YYYY FEE SCHOOL DISTRICT (I.E. 63, 67, 70, ETC.) - - - - - - - - - METHOD OF PAYMENT ENCLOSED TOTAL PAID $ □ CASH □ CHECK (Payable to Morton Grove Park District) □ MASTERCARD □ VISA □ DISCOVER □ AMERICAN EXPRESS Account Number _______________________________ Expiration Date __________ CSC (Security Code) ______________ Cardholder Name __________________________________ Authorized Signature _________________________________ Waiver & Release of All Claims and Assumption of Risk Please read this form carefully and be aware that in signing up and participating in these programs, you will be expressly assuming the risk and legal liability and waiving and releas- ing all claims for injuries, damages or loss which you or your minor child/ward sustain as a result of participating in any and all activities connected with and associated with said programs/activities (including transportation services/vehicle operations, when provided). "I recognize and acknowledge that there are certain risks of physical injury to participants in these programs/activities, and I voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that my minor child/ward or I may sustain as a result of said participation." I further agree to waive and relinquish all claims I or my minor child/ward may have (or accrue to me or my child/ward) as a result of participating in these programs/activities against the Morton Grove Park District, including its offi cials, agents, volunteers and employees (hereinafter collectively referred as "Morton Grove Park District"). "I do hereby fully release and forever discharge the Morton Grove Park District from any and all claims for injuries, damages, or loss that my minor child/ward or I may have or which may accrue to me or my minor child/ward and arising out of, connected with, or in any way associated with these programs/activities". I have read and fully understand this waiver and understand my signature or my parent/guardian's signature if I'm under 18, is required to take part in Park District program. Signature: _____________________________________________________ Date____________________ PLEASE MAIL REGISTRATION TO MORTON GROVE PARK DISTRICT, 6834 DEMPSTER STREET, MORTON GROVE, IL 60053 NAME OF PARTICIPANT REQUIRING SPECIAL ACCOMMODATIONS. AMERICAN WITH DISABILITIES ACT Yes, ____________________________ needs accommodations. 58

• 2021 Summer Activity Guide Cover1-2
• 2021-Summer Activity Guide
• 2021 Summer Activity Guide Cover3-4