ࡱ> JLI` :bjbj *> HHH\4T\@t((((}oL$,hQH["}((3R(H(&"H(h (_$0@   HHO lOOOOOO@\\\ \\\\\\ Franklin Parks and Recreation Department Adult Registration Form PLEASE PRINT FIRMLY AND LEGIBLY Participant s Last Name  FORMTEXT      First Name  FORMTEXT      Age  FORMTEXT      Address  FORMTEXT      Telephone  FORMTEXT    - FORMTEXT    - FORMTEXT     Birth Date  FORMTEXT   - FORMTEXT   - FORMTEXT     Program  FORMTEXT      Business Telephone  FORMTEXT    - FORMTEXT    - FORMTEXT     Home Phone  FORMTEXT    - FORMTEXT    - FORMTEXT     Person to notify in an emergency  FORMTEXT      Relationship  FORMTEXT      Telephone  FORMTEXT    - FORMTEXT    - FORMTEXT     List any medical problems or conditions  FORMTEXT       List any special concerns  FORMTEXT        Parks & Recreation Department encourages registrants to carefully consider their schedule prior to registration. No fee will be refunded after the programs begin. This policy will be strictly enforced. If a program is canceled by the department, you will be notified and the full fee will be refunded. Please Read Carefully: In consideration for participation in any Franklin Parks & Recreation Department Program, I hereby release, waive and discharge the City of Franklin, the Franklin Parks and Recreation Department, any subdivision thereof and their agents, representatives and employees from all liability for any and all loss of damage and claims or demands on account of injury to the person or property, or resulting in the death of the named participant whether caused by the negligence of the City of Franklin, the Franklin Parks and Recreation Department, their agents, representatives or employees or any other entity, regardless of whether liability is sole, joint or several. I further covenant not to sue on behalf of myself or the injured party the City or Franklin, its Parks and Recreation Department, its agents, representatives or employees as a result of any such injury listed above or any injury which results from participation in any program of the City. I specifically acknowledge that I am aware that participation in a City program presents the opportunity for strain or injury to my body and I represent to the City and department that to the best of my knowledge I am in good physical condition. I further assume all risk of participating in such programs. I further recognize that the City of Franklin nor its Parks and Recreation Department can provide transportation for all programs. I understand that volunteer drivers may be used for travel and hereby release, waive and discharge any such driver for all liability and loss to the same extent as if said transportation were provided by the City of Franklin. I further give permission for the participant as listed above to be treated by medical personnel selected by the City of Franklin on an emergency basis and further agree to assume full financial responsibility for such actions being taken on my behalf. Further more I give permission RT      2 4 6 J L N X Z \ b d f z | ~ ȸΨΟȏΨΟΨoΨΟjh(h%CJUjh(h%CJUjth(h%CJUhP.8h(CJjh(CJUmHnHujh(h%CJU h(CJjh(CJU hP.8CJhP.8hP.8CJhP.8 hP.8hP.8he h( he CJ(+R 4 \ d $IfgdP.8$a$gdP.8gdP.8$a$ :: H ^ qhhhhhh $IfgdP.8kd\$$IflF F$Ao t0h6    44 la4     " $ 8 : < D F H ^ ` t v x | ~ xhjh(h%CJUjh(h%CJUjh(h%CJUhP.8hP.8CJhP.8h(CJj4h(h%CJUjh(h%CJUjh(CJUmHnHujJh(h%CJU h(CJjh(CJU hP.8CJ(  & ( * > @ B H J L N b d f l n p r ̼̣̓̃sjXh(h(CJUjh(h%CJUjlh(h%CJUjh(h%CJUhP.8h(CJjh(h%CJU h(CJ hP.8CJhP.8hP.8hP.8CJjh(CJUmHnHujh(CJU-  (  qhhhhhh $IfgdP.8kd $$IflF F$Ao t0h6    44 la4      \ ^ ` t v x   𷳷𔷭𔷭tj h(h(CJUj h(h%CJUhP.8h(CJj2 h(h%CJU hP.8CJhP.8hP.8hP.8CJjBh(h(CJUjh(CJUmHnHujh(h(CJUjh(CJU h(CJ-  ^ J qhhhhhh $IfgdP.8kd$$IflF F$Ao t0h6    44 la4   " $ & : < > F H J L   "$.068<@DFHϿ嶲Ϝ哶σ嶲}rh/he CJaJ he CJj h(h%CJUhP.8h(CJj h(h%CJU hP.8CJhP.8hP.8hP.8CJj h(h(CJU h(CJjh(CJUmHnHujh(CJUj h(h(CJU)J L qhhhh $IfgdP.8kd~ $$IflF F$Ao t0h6    44 la4 qhhhh $IfgdP.8kd| $$IflF F$Ao t0h6    44 la4 246qhhhh $IfgdP.8kd< $$IflF F$Ao t0h6    44 la468:<>@qhhhh $IfgdP.8kdr$$IflF F$Ao t0h6    44 la4@BDFUm+E8qlgSCSS$|]|^a$gd/$|]|^`a$gd/dgdP.8kd$$$IflF F$Ao t0h6    44 la4H,Uk8999^9_9c9d9:::Žŷųh^ he CJjhe Uhe he CJ he CJUh,gCJaJh`Y8CJaJh/h/5>*CJaJh/h/CJaJto be photographed for the city of Franklin programs and promotions. I have read this release and understand all its terms. I execute it voluntarily and with full knowledge of its significance and legal consequences. I execute this release on the date indicated below. Participants Signature________________________________ Date________________  Return Registration & Payment to: Franklin Parks and Recreation Department 124 Memorial Street, Franklin, NH 03235 Make Check Payable to: CITY OF FRANKLIN Total Fee________ Payment________ Payment________ Payment________ Date____________ Date___________ Date___________ Date___________ Sub Total_______ Sub Total_______ Sub Total_______ E8999^9`9a9b9c9d999::H:::::: $@ ^@ `a$$a$|]|^`gd/(/ =!P"P#$% tDText1tDText2tDText3x$$If4!vh5&5X 5J#v&#vX #vJ:Vl th65A5o5a4tDText4tDText5vDText10vDText11tDText6vDText12vDText13x$$If4!vh5&5X 5J#v&#vX #vJ:Vl th65A5o5a4tDText7tDText8vDText14vDText15tDText8vDText14vDText15x$$If4!vh5&5X 5J#v&#vX #vJ:Vl th65A5o5a4vDText17vDText16tDText8vDText14vDText15$$If4!vh5&5X 5J#v&#vX #vJ:Vl th65A5o5/ a4vDText18$$If4!vh5&5X 5J#v&#vX #vJ:Vl th65A5o5/  / / / / a4$$If4!vh5&5X 5J#v&#vX #vJ:Vl th65A5o5/  / / / / a4vDText19$$If4!vh5&5X 5J#v&#vX #vJ:Vl th65A5o5/  / / / a4$$If4!vh5&5X 5J#v&#vX #vJ:Vl th65A5o5/  / / / a4<@< NormalCJ_HmH sH tH >@> Heading 1$d@&CJ D@D Heading 2$$d@&a$CJ$DA@D Default Paragraph FontVi@V  Table Normal :V 44 la (k@(No List HC@H Body Text Indent `CJTT@T Block Text $*]*^`a$5\H@H |# Balloon TextCJOJQJ^JaJVY@"V ^ Document Map-D M CJOJQJ^Jj@3j P.8 Table Grid7:V0 >)BCc{$/dem /CPdn !"#Um+& ? 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SharlowOh+'0 ,D `l    ,Franklin Parks and Recreation Department,Franklin Parks and Recreation DepartmentadultwaiverformDenise M. Sharlow2Microsoft Office Word@@x@^H@^H ՜.+,D՜.+,d  hp  Franklin Rec Center  )Franklin Parks and Recreation Department Title,@ _AdHocReviewCycleID_EmailSubject _AuthorEmail_AuthorEmailDisplayName_ReviewingToolsShownOnce lv,alavertu@franklinnh.orgAmanda Lavertu !"#$%&')*+,-./012345678:;<=>?@BCDEFGHKRoot Entry FʴMData  1Table( WordDocument*>SummaryInformation(9DocumentSummaryInformation8ACompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q