Drama Class Registration Form

Billie Limacher Bicentennial Park

Release & Hold Harmless Agreement

The undersigned shall be solely responsible for and shall hold harmless, release and discharge the CITY OF JOLIET and its officers and agents, employees and the WILL-JOLIET BICENTENNIAL PARK, INC and its officers, agents, and employers against all injuries, death, losses, damages, claims, suits, liabilities, causes of action, judgments, costs, and expenses, including attorney's fees, which may in any way accrue directly or indirectly against the CITY OF JOLIET and its officers, agents, and employees and the WILL-JOLIET BICENTENNIAL PARK, INC and its officers, agents, and employees as a result of the undersigned's participation in any program, function, or event sponsored by the WILL-JOLIET BICENTENNIAL PARK, INC or held on the premises of the WILL-JOLIET BICENTENNIAL PARK, INC. The undersigned understands that this document is a RELEASE OF LIABILITY and has signed the document freely and voluntarily (or, in the case of a minor, the minor's parent or guardian has signed it freely and voluntarily on behalf of the minor).

Please fill out and return with payment (payable to Bicentennial Park) to:

Billie Limacher Bicentennial Park

201 West Jefferson at Bluff Street

Joliet, IL  60435

Student's name (printed):                                                                                                                           

Age:                            Birthday:                                                                  Grade:                                    

                                                                                                                   (Grade going into in the fall)

Address:                                                                                                                                                  

City, Zip:                                                                             E-mail:                                                          

Home phone:                                                                       Cell:                                                            

Emergency phone:                                                                                                              

Approved adult chaperones:

1. Name:                                                       Relation:                                  Phone:                                    

2. Name:                                                       Relation:                                  Phone:                                    

3. Name:                                                       Relation:                                  Phone:                                    

If you need to add a chaperone or give approval to carpool, you must contact the teacher and provide written consent.

Anyone NOT allowed contact:                                                                                                                     

Adult's signature:                                                                                                                                      

Adult's name (printed):                                                                                                                                   

                                                                                                                  (Please state relation to student)

 Date signed:                                                                      

For additional safety reasons, please advise your children NO FLIP-FLOPS are to be worn.  Thank you.