Streamwood Park District - S.P.D. C.A.R.E.S.!

Welcome to the
Internet Club
E-mail registration.

You must be a InternetClub Member before this registration option can be utilized. If you are not an InternetClub member STOP!
Because our web site is not secure you must be a InternetClub member, meaning, we must have your personal and payment information
on file in our office before you may take advantage of this registration service.

To receive information on the InternetClub, e-mail us with your name, address, phone number and e-mail address at registration@streamwoodparkdistrict.org or call (630) 372-7275 x3025 to receive the appropriate forms and information.

If you would like to register more than one person please fill out a new form for each individual and submit each form separately.

*Please enter the following information:*
Household Number:
Home Phone:
Participants Name (first and last):

1st Class Choice / Class #:
Program Name:
Day and Dates:
Time:
Fee:

2nd Class Choice / Class #:
Program Name:
Day and Dates:
Time:
Fee:


If the participant listed above is NOT part of your household, please list the following information for the the participant:
Name (first and last):
Male/Female:	Male or Female
Age:
Birth date:
Street Address:
City:
State:
Zip:
Home Phone:
Emergency Phone and Contact Name:

Payment Method: This has to be the credit card we have on file when you signed up for the Internet Club
Credit Card Name	VISA or MC or Discover Card
Only the last four digits of card:
Fee to be charged:

The Streamwood Park District welcomes individuals with disabilities into programs. Please describe any accommodation needed for successful inclusion in the program(s):

Important!
Read the waiver below and sign below to complete the form!
Program Registration Waiver
Important Information
The Streamwood Park District is committed to conducting its recreation programs and activities in a safe manner and holds the safety of participants in high regard. The Streamwood Park District continually strives to reduce such risks and insists that all participants follow safety rules and instructions that are designed to protect the participants’ safety. However, participants and parents/guardians of minors registering for programs/activities must recognize that there is an inherent risk of injury when choosing to participate in recreational activities/programs.

You are solely responsible for determining if you or your minor child/ward are physically fit and/or skilled for the activities contemplated by this agreement. It is always advisable, especially if the participant is pregnant, disabled in any way or recently suffered an illness, injury or impairment, to consult a physician before undertaking any physical activity.

Warning of Risk
Recreational activities/programs are intended to challenge and engage the physical, mental and emotional resources of each participant. Despite careful and proper preparation, instruction, medical advice, conditioning and equipment, there is still a risk of serious injury when participating in any recreational activity/program. Understandably, not all hazards and dangers can be foreseen. Depending on the particular activity, participants must understand that certain risks, dangers and injuries due to inclement weather, slipping, falling, poor skill level or conditioning, carelessness, horseplay, unsportsmanlike conduct, premises defects, inadequate or defective equipment, inadequate supervision, instruction or officiating, and all other circumstances inherent to indoor and outdoor recreational activities/programs exist. In this regard, it must be recognized that it is impossible for the Streamwood Park District to guarantee absolute safety.

Waiver and Release of All Claims and Assumptions of Risk
Please read this form carefully and be aware that in signing up and participating in the above identified programs/activities, you will be expressly assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or loss which you or your minor child/ward might sustain as a result of participating in any and all activities connected with and associated with said programs/activities (including transportation services/vehicle operation, when provided).

I recognize and acknowledge that there are certain risks of physical injury to participants in these programs/activities, and I voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that my minor child/ward or I may sustain as a result of said participation. I further agree to waive and relinquish all claims I or my minor child/ward may have (or accrue to me or my child/ward) as a result of participating in these programs/activities against the Streamwood Park District, including its officials, agents, volunteers and employees (hereinafter collectively referred as "Streamwood Park District").

I do hereby fully release and forever discharge the Streamwood Park District from any and all claims for injuries, damages, or loss that my minor child/ward or I may have or which may accrue to me or my minor child/ward and arising out of, connected with, or in any way associated with these programs/activities.

I have read and fully understand the above important information, warning of risk, assumption of risk and waiver and release all claims. When registering on-line, your signature on file and acceptance of this waiver shall substitute for and have the same legal effect as an original form signature.
I ACCEPT AND UNDERSTAND THE TERMS ABOVE: Yes or No

Name (participant or parent/guardian 18 years or older):

Date:
Email:

IF THE TERMS ABOVE ARE NOT ACCEPTED, YOUR E-MAIL REGISTRATION WILL NOT BE PROCESSED.

Note: If you've accepted the terms and submitted the form, you may get a message that the email didn't go thru, please ignore this message. If you don't receive confirmation via phone or separate email within the next business day, please call us to confirm receipt at (630)483-3025.

Disclaimer: Privacy of information submitted on this e-mail form is not guaranteed. This site www.streamwoodparkdistrict.org is not secure.

Privacy Policy: The personal and private information collected by the Streamwood Park District from any individual(s) is intended for the sole use of the District, and such information will not be sold or distributed to other persons or agencies without the written permission of the individual(s) providing it, except as required by law. If information is provided to any other person or agency pursuant to any legal requirement, the District will advise the individual(s) of the disclosure.