Recreation_Program_Registration_LilHoopersMarchMadness

City of Ionia

Recreation Program Registration Form

- Lil’ Hoopers March Madness -

$50 Resident / $60 Non-Resident Per Participant

Parent or Legal Guardian Information

First Name

Middle Name

Last Name

Street Address

City

State

Zip Code

Home Phone

Cell Phone

Work Phone

Email Address

required

Emergency Contact

City of Ionia: Do You Reside Within the City Limits?

Yes No

required

Township: Specify, If You Answered NO to Previous Question

Would You Like to Coach?

Yes No

Participant Information

You may enter up to three (3) participants with this registration form. Information must be completely entered for each participant.

How Many Participants?

One (1) Two (2) Three (3)

PARTICIPANT ONE (1)

First Name

Last Name

Birthdate

Age

Shirt Size

Current School Grade?

Special Request: Coach? Friend(s)?

PARTICIPANT TWO (2)

First Name

Last Name

Birthdate

Age

Shirt Size

Current School Grade?

Special Request: Coach? Friend(s)?

PARTICIPANT THREE (3)

First Name

Last Name

Birthdate

Age

Shirt Size

Current School Grade?

Special Request: Coach? Friend(s)?

Waiver of Liability

In consideration of the furtherance of your purposes, objectives and work and in consideration of your permitting me, my child, ward or heir to participate in any program (s) or event (s) pertaining to the City of Ionia, Department of Parks and Recreation or the Ionia School District., I the undersigned, or if under 18 my parent or guardian, INTEND TO BE LEGALLY BOUNDED HEREBY WAIVE AND RELEASE ANY AND ALL RIGHTS AND CLAIMS FOR DAMAGES WHETHER BASED UPON NEGLIGENCE OR ANY OTHER THEORY OF LAW, which I, my child, ward, or heir and our parents, guardians, heirs, executors, representatives, administrators, and assigns may have against The City of Ionia, department of Parks and Recreation, the Ionia School District., any affiliates or subsidiaries, officers, directors, shareholders, agents, employees associated with said corporations and associations, the municipalities or counties in or through which the programs or events take place or are conducted, as well as any other person, entity or sponsor connected with such programs or events, and their heirs, executors, representatives, administrators, successors, assigns, affiliates, officers, subsidiaries, directors, shareholders, employees or agents, FOR ANY AND ALL INJURIES INCLUDING DISABILITATING INJURY AND / OR DEATH OR DAMAGES WHICH I, MY CHILD, WARD OR HEIR MAY SUFFER while taking part in such programs or events as a result thereof.

Do You Agree to the Waiver of Liability?

Yes No

“Yes” must be checked

Program Registration Online Payment

$50 Resident / $60 Non-Resident Per Participant

By submitting this form, you are agreeing to pay the registration fee online. If you do NOT have receipt of payment, you may be dropped from the enrollment of this activity.

Do You Agree to Pay Online?

Yes No

“Yes” must be checked

Now You Must Make PAYMENT To Complete Your Registration.
(1) Please note the total fees to be paid.
(2) Check the "I'm not a robot" box below.
(3) Click the "Submit" button below. You will then be directed to the online payment system.