ACTIVITY REGISTRATION FORM
Mail to: Recreation Registration City of El Cajon 200 Civic Center Way El Cajon, CA 92020-3916
www.elcajonrec.org On-Line - Beat the Crowd!
Walk-in to any Recreation Center During In-person Registration Dates and Operational Hours
(or)
(or)
Adult/Guardian Name: Last Address:
First
Zip:
Apt #: Secondary Phone:
City:
Primary Phone:
@
Text Message Alert Phone:
Agree to receive text messages
Cell Phone Carrier
E-Mail Address:
E-Mail address is required for the internet Registration's "Forgot My Password" feature. E-Mail will be used for registration, confirmation, and to provide information regarding City Recreation programs. Under no circumstances will e-mail addresses be sold to outside agencies. E-Mail to you will not disclose other e-mail addresses.
Y/N
Date of Birth
Course # (1st Choice)
Course # (2nd Choice)
Participant's Name
Class Name
Grade
Fee
/ / / / / / / / / /
$
$
$
$
$ $ Yes! I would like to donate to the youth scholarship fund. TOTAL FEES ENCLOSED:
FOR OFFICE USE ONLY:
Staff:
Date: Check Check#
Discover $ The City of El Cajon endeavors to be in total compliance with the Americans with Disabilities Act (ADA). Individuals who wish to participate in City Recreation programs and activities and who may need accommodation, please contact the Recreation Supervisor at 441-1670 a minimum of two weeks in advance of the program start date in order to process the request. READ, SIGN & DATE WAIVER Registration cannot be completed until waiver is signed below. Cash Visa Mastercard AMEX By signing this Waiver, I release the City of El Cajon, the El Cajon Recreation Department, and its officers, agents, employees and volunteers from any and all liability for any claim for personal injury, or property damage arising as a result of my, my family’s or my organization’s participation in recreation activities. In the event of any claim or action, including any claims for negligence against the City, I will indemnify and hold harmless from any and all damages the City of El Cajon, the El Cajon Recreation Department, and its officers, agents, employees and volunteers, and will pay all costs incident to any such claim including, without limitation, attorney’s fees. I understand there are certain risks inherent in this activity and I assume all risk associated with this event on my own behalf or on behalf of any minor or dependent child or children participating in this event. I grant full permission for this event’s sponsors to use my/my child’s name, voice and/or picture in any media or other account of this event for any purpose. I further grant permission for event sponsors to solicit feedback on the program from my child. No city agent may modify this waiver. SIGNATURE: DATE: Payment:
This activity is not a school sponsored activity and is not endorsed by the school or Cajon Valey School District. The activities, products, or services advertised in this guide are not endorsed by the school or the District. This event/activity is sponsored by the City of El Cajon Recreation Department and is not La Mesa/ Spring Valley District approved.
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