Brookside Summer Blast 2017 Registration

Welcome to online registration!

Please complete all information including the agreement and release form at the end.

If you need to register more than four children, please begin a second form.

Thank you for signing up for Brookside Summer Blast 2017!

Parent/Guardian contact information:

Agreement and Release:

NOW, THEREFORE, in consideration of the undersigned engaging in the Activities, the undersigned states and agrees as follows:

1.Participant and Parent (if applicable) accept responsibility for the payment of all charges, and expenses for medical and hospital care as well as transportation fees to and from medical facilities that may be incurred by Participant arising out of injuries related to the Activities. Further, Participant and Parent (if applicable) authorize Releases to seek and/or administer emergency medical care on behalf of Participant.

2.Participant and Parent (if applicable) for themselves and their heirs and assigns, herby release Brookside, its officers, agents, directors, employees and all other persons or volunteers providing any services or equipment in any way related to the Activities (“releases”), from any and all claims, demands and liability due to death, injury or property damage, arising from or in any way related to the Activities, including the provision of medical services by Releases.

3.If Participant is under eighteen (18) years of age, the Parent signing this Agreement and Release represents and warrants (A) that said Parent has been appointed guardian of said Participant and has the authority to release claims of said Participant; of (B) if said Parent has not been appointed guardian of the Participant, or is without the authority to execute this Agreement and Release on behalf of the Participant, that the Parent hereby agrees to defend and indemnify the Releases from any and all claims made by the Participant against Releases.

4.Your participation in this event constitutes permission for Brookside to use your and/or your child's photo in our building and online.

Thank you for registering your children for Brookside Summer Blast at Brookside this summer! Please arrive at 8:30am on June 19 to check in.