PLEASE Bring this registration form with you.

WILBRAHAM PARKS & RECREATION DEPARTMENT
45C POST OFFICE PARK
WILBRAHAM, MA 01095
HIKING REGISTRATION
DATE OF EVENT: ________________________
LOCATION: _______________________
NAME(s):__________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
ADDRESS:_________________________________________________________________________________
(STREET, CITY, ZIP)
EMAIL ADDRESS: __________________________________________ We may send info. via email,
please check yours regularly.
HOME PHONE: _____________________________ CELL: __________________________________
EMER. NAME_______________________________ CONTACT NUMBER::_________________________
WILBRAHAM PARKS & RECREATION DEPARTMENT WAIVER
I, the undersigned do hereby consent to my (and my family’s) participation in voluntary recreational programs of the Town of
Wilbraham. I agree not to sue and also agree to forever release the Town of Wilbraham, and the H.W. School District their
servants, officers, officials, employees, agents and (“the releasees”) assisting or participating in voluntary recreational
programs of the Town of Wilbraham from any and all claims, rights of action and causes of action that may arise in the past,
or may arise in the future, directly or indirectly, from personal injuries me or my family members or property damage resulting
from our participation in the Town of Wilbraham voluntary recreational programs.
I also promise, to indemnify, defend, and hold harmless the releasees against any and all legal claims and proceedings of
any description that may have been asserted in the past, or may be asserted in the future, directly or indirectly, arising from
personal injuries to me or my family members or property damage resulting from my or my family member’s participation in
the Town of Wilbraham voluntary recreational programs.
I further affirm that I have read this Consent and Release Form and that I understand the contents of this form. I understand
that my/ my family’s participation in these programs is voluntary and that my family and I are free to choose not to participate
in said programs. By signing this form, I affirm that I have decided to allow my child(ren) to participate in the Town of
Wilbraham’s recreational programs with full knowledge that the releasees will not be liable to anyone for personal injuries
and property damage my family or I may suffer in voluntary Town of Wilbraham recreational programs.
By signing below, I acknowledge that I have carefully read and assent to the above releases.
__________________________________________________________
SIGNATURE OF PARTICIPANT/PARENT/GUARDIAN
_______________
DATE
PLEASE Bring this registration form with you.