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.
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