COSTA MESA RESIDENT PRIORITY REGISTRATION BEGINS May 6, 2025 ONLINE | cmclassesonline.com WALK-IN | City Hall M-F: 8:00 am-4:30 pm MAIL IN | Check/Money Order payable to CITY OF COSTA MESA MAIL TO | Costa Mesa Parks and Community Services | P.O. Box 1200 | Costa Mesa, CA 92628
OPEN REGISTRATION BEGINS May 13, 2025
WAIVER - MUST BE SIGNED
REGISTRATION POLICIES
GENERAL POLICIES: I, the undersigned, understand and agree to the General Policies set forth herein. I further understand that if a participant has previously been or is the subject of discipline, suspension, or expulsion in connection with any City recreation programs, or has exhibited disruptive conduct, the City may, in its discretion, immediately unenroll the participant. ASSUMPTION OF RISK: I fully understand that my or my child/children’s participation in City Recreation programs may expose me or my child/children to the risk of personal injury, death and/or property damage. I hereby acknowledge that participation in City programs is voluntary and I agree to assume the full risk of any injuries and/or damages and/or losses of property, regardless of severity and including death, that may occur in connection with my or my child/children’s participation in City programs. PHOTO RELEASE: I understand that City representatives may photograph or record activities of City programs and participants. I hereby grant permission for the City to use and/or publish my or my child/children’s photograph or likeness photographed or recorded during my or my child/children’s participation in City programs to promote City programs and services, and for any other purpose, without compensation to me or my child/children. MEDICAL RELEASE: I authorize the City to provide or cause to be provided such medical treatment to me or my child/children as may be necessary or appropriate if any injury occurs during my or my child/children’s participation in City recreation programs. I further agree to pay any and all costs incurred in connection with such treatment. CIVIL CONDUCT POLICY: I understand that the Recreation Division’s Civility Conduct Policy is intended to provide a safe, friendly and comfortable environment for participants and staff by requiring that everyone “treat others the way you want to be treated.” I understand that any participant that violates the Civility Conduct Policy may, depending on the severity of the violation, be subject to disciplinary action, including, but not limited to, a verbal warning, immediate removal from the program/event, and/or denial of future participation in City programs. WAIVER and RELEASE OF LIABILITY: I, intending to be legally bound for myself and my heirs, personal representatives, next of kin, and anyone who might make a claim on my behalf, hereby waive, release, and discharge the City of Costa Mesa, and its elected officials, officers, agents, employees, and volunteers from any and all claims for damages and/or liability, whether caused by any active or passive negligent act or omission of the City of Costa Mesa, or its elected officials, officers, agents, employees, and/or volunteers, or otherwise related to my or my child/children’s participation in City programs, and promise not to sue the City of Costa Mesa, or its elected officials, officers, agents, employees, and/or volunteers for any damages I incur in connection with the City’s programs. This release and waiver extends to all claims of every kind of nature whatsoever, foreseen or unforeseen, known or unknown. As part of our commitment to the “Americans with Disabilities Act” and our participants, are there any special accommodations needed for your participation in the above mentioned activities? Yes No If Yes, please explain: Please note that we cannot know how to provide reasonable accommodation unless specified by you.
1. All credit card transactions are subject to a non-refundable credit card processing fee. 2. Class withdrawals must be made in writing and submitted prior to the second scheduled class. Withdrawls for classes that meet fewer than three times must be made 24 hours prior to the start of the first class. A $5 (refund) or $3 (transfer) fee will be charged per class. The $5 Administrative Fee and credit card processing fees are non-refundable. *Specific program refund policy may vary. 3. If class is cancelled by the instructor or department, participant will be notified and a refund will be processed. Please allow up to eight weeks for refunds. Credit card processing fees are non-refundable. 4. A service charge will be required on all returned checks. 5. Registration will not be taken at class. 6. All classes/programs are subject to change/cancellation.
MANDATORY SIGNATURE
DATE:
REGISTRATION WILL NOT BE PROCESSED UNLESS WAIVER IS SIGNED
PAYEE/ADULT INFORMATION - PLEASE FILL OUT COMPLETELY ADULT NAME: FIRST LAST
PHONE: PRIMARY
PHONE: SECONDARY
ADDRESS
CITY
ZIP CODE
EMAIL ADDRESS
ADULT DOB
PARTICIPANTS NAME(S)
DATE OF BIRTH M/F CLASS NAME
NUMBER START DATE FEE
$ 88
e.g. Bradley Smith
05/09/1994
M Traditional Karate
17139
07/20/2023
1 2 3 4 5
$ $ $ $
$ Administrative Fee ($5) $5 Non-Resident (number of classes x $5) $ Total Paid $
Money Order
Please make your check payable to: City of Costa Mesa
Cash
Check #
Credit Card** (All major credit cards accepted)
Credit Card Holder’s Name:
** In-Person/Mailed credit card payments are subject to a 3% processing fee**
CC Security Code:
Credit Card Number:
Expiration Date:
OFFICE USE ONLY DATE RECEIVED
TIME RECEIVED
ENTERED BY
DATE ENTERED
RECEIPT NUMBER
Revised 7/22
The Spotlight | Summer 2025 Recreation, Arts, Events, and Parks!
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VISIT US ONLINE AT COSTAMESACA.GOV/RECREATION
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