You must be a InternetClub
Member before this registration option can be utilized. If you are not an
InternetClubmember 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 officebefore 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@SpdCares.com
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.
or
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.>
Summer