Registration Bloomington Parks and Recreation Staff .................inside back cover

Online registration available 24-7. bloomington.in.gov/parks

Secured for credit card payment.

VISA, MASTERCARD, or DISCOVER

Register in person by coming to the atrium of City Hall at 401 N. Morton St., Ste. 250, Monday–Friday, 8 a.m.–5 p.m.

VISA, MASTERCARD, DISCOVER, CASH, CHECK, or MONEY ORDER

Mail in

Complete the registration form and send it to

Bloomington Parks and Recreation 401 N. Morton St., Ste. 250 Bloomington, IN 47404

Registrations must be received before the deadline.

CHECK or MONEY ORDER

Drop off

A convenient drop box is located outside City Hall, at the “401” address doors. Drop off your registration after hours or whenever it’s convenient for you. Make sure you drop off before the registration date.

CHECK or MONEY ORDER

For information about resident status, fees and charges, liability waivers, registration, and refunds, visit: bloomington.in.gov/parks/registration

PROGRAM REGISTRATION FORM

(parent/guardian if participant is under 18 or under legal guardianship)

Street Address Home Phone

Work Phone

City State Zip

City of Bloomington Resident? Yes No

(If you are unsure of your residency status, please call 812-349-3700)

Emergency Contact

E-mail Address

How did you hear of this program? Program Guide Social Media Newspaper Flier Friend Email Website Previous Participant Other

Participant Name

Gender Birthdate Shirt Size Program Name Class Code Fee

Inclusive Service Request:

Reasonable accommodations are needed to participate in above program(s) related to specific needs associated with a disability. (circle one)

YES NO

If YES, please complete an Inclusion Assessment and the Inclusive Recreation Coordinator will contact you. We request at least two weeks notification for reasonable accommodations requests. In some cases reasonable accommodations may take longer.

Parks and Recreation Program Waiver Statement

The undersigned is the adult program participant, or is the parent or legal guardian of the program participant. The undersigned hereby states that s/he understands the activities that will take place in this program, and that the program participant is physically and mentally able to participate in this program. The undersigned recognizes, as with any activity, there is risk of injury. In the event that the program participant sustains an injury in the course of the program, and the Bloomington Parks and Recreation Department is unable to contact the appropriate person(s) to obtain consent for treatment, the Department and/or its employees or volunteers are authorized to take reasonable steps to obtain appropriate medical treatment. The program participant and/or his/her parent or legal guardian shall be responsible for the cost of such treatment. The undersigned now releases the City of Bloomington, the Bloomington Parks and Recreation Department, its employees, agents, and assigns, from any claims including, but not limited to, personal injuries or damage to property caused by or having any relation to this activity. It is understood that the release applies to any present or future injuries and that it binds the undersigned, undersigned’s spouse, heirs, executors and administrators. The Program Participant may be photographed and videotaped while participating in Parks and Recreation activities and while attending Parks and Recreation events, and consent is given for the reproduction of such photos or videos for advertising and publicity.

Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is highly contagious and is believed to spread mainly from person-to-person contact. Bloomington Parks and Recreation Department has put in place preventative measures to reduce the spread of COVID-19; however, the Department cannot guarantee that the program participant, or the program participant’s household members will not become infected with COVID-19. Further, attending the program could increase the risk of the program participant, or the program participant’s household members of contracting COVID-19. By signing this agreement, the undersigned acknowledges the contagious nature of COVID-19 and voluntarily assumes the risk that the program participant, or other members of the program participant’s household may be exposed to or infected by COVID-19 as a result of attending the program and that such exposure or infection may result in personal injury, illness, permanent disability, and death. The undersigned also acknowledges and understands that all of the risks of COVID-19 are not known and that the risk of becoming exposed to or infected by COVID-19 at the program may result from the actions, omissions, or negligence of the program participant and others, including, but not limited to, Bloomington Parks and Recreation employees, volunteers, and other program participants and their families. The undersigned voluntarily agrees to assume all of the foregoing risks, known and unknown, and accept sole responsibility for any injury or loss to the program participant, and other members of the program participant’s household. The undersigned hereby waives, releases, discharges, and agrees to hold harmless, indemnify, and not sue Bloomington Parks and Recreations Department, its employees, agents, officers, directors, affiliates, members, volunteers, and representatives (collectively, “Releasees”), of and from any and all claims, liabilities, actions, damages, costs or expenses of any kind arising out of or relating thereto. The undersigned further agrees that this release includes any Claims based on the actions, omissions, or negligence of the Releasees, whether such claim arises before, during, or after participation in any Parks and Recreation program. I have read and understand all of the foregoing terms. I agree with the terms and sign voluntarily.

Include Your Voluntary Donation to the Bloomington Parks & Recreation Department Community Garden Fund Bloomington Tree Fund Greatest need Total Enclosed

$1 $3 $5 Other $

Method of Payment: Cash (do not mail cash) Check/Money Order

Make check or money order payable to: City of Bloomington Parks and Recreation Mail registrations to: City of Bloomington Parks and Recreation 401 N. Morton Street, Ste. 250, Bloomington IN 47404

Staff at their 2021 retreat at Banneker Community Center.

Administration

Paula McDevitt................................................................... Administrator mcdevitp@bloomington.in.gov • 349-3711 Emily Buuck............................................Community Relations Coordinator emily.buuck@bloomington.in.gov • 349-3739 Ellen Campbell ........................................................................Graphic Designer campbele@bloomington.in.gov • 349-3799 Kim Clapp......................................................................................Office Manager clappk@bloomington.in.gov • 349-3710 Missy Grabowski..................................... Customer Service Representative grabowsm@bloomington.in.gov • 349-3700 Tiffany Hall................................................ Customer Service Representative halti@bloomington.in.gov • 349-3702 Brenda McGlothlin................................. Customer Service Representative mcglothb@bloomington.in.gov • 349-3701 Ethan Philbeck......................................... Customer Service Representative philbece@bloomington.in.gov • 349-3757 Julie Ramey................................................... Community Relations Manager rameyj@bloomington.in.gov • 349-3719

Operations and Natural Resources

Tim Street................Operations and Development Division Director tim.street@bloomington.in.gov • 349-3706 John Barnes....................................................................................................... MEO barnesj@bloomington.in.gov Jon Behrman......................................... Natural Areas Working Foreperson behrmanj@bloomington.in.gov Steve Cotter......................................................... Natural Resources Manager cotters@bloomington.in.gov • 349-3736 Barb Dunbar...............................................Operations Division Coordinator dunbarb@bloomington.in.gov • 349-3498 Don Foddrill ....................................................Facilities Working Foreperson foddrild@bloomington.in.gov Dave Fox.............................Sanitation and Grounds Working Foreperson foxd@bloomington.in.gov Curtis Gilstrap ................ Cemeteries/Landscaping Working Foreperson Bob Grubb.................................................................Urban Forestry, Laborer II Erin Hatch.......................................................................................Urban Forester erin.hatch@bloomington.in.gov • 349-3716 Mike Hollingsworth................................ Facilities Maintenance Mechanic Mark Marotz .........................................................Operations Superintendent marotzm@bloomington.in.gov • 327-6119 Phil Paris ....................................................................................................Laborer II Anthony Robertson........................... Equipment Maintenance Mechanic robertsa@bloomington.in.gov Dennis Robertson............................................................................................ MEO Jim Salisbury ............................................................................................Laborer II Haskell Smith ......................................Urban Forestry Working Foreperson smithh@bloomington.in.gov Joanna Sparks.............................................................................City Landscaper sparkj@bloomington.in.gov • 349-3497 Scot Sturrock...............................Urban Greenspace Working Foreperson scot.sturrock@bloomington.in.gov Rebecca Swift................................................Natural Resources Coordinator rebecca.swift@bloomington.in.gov • 349-3759 Rob Turpin ..................................................................Operations Crew Leader turpinr@bloomington.in.gov

Recreation

Becky Higgins........................... Recreation Services Division Director barrickb@bloomington.in.gov • 349-3713 Clarence Boone..........................................Community Events Coordinator clarence.boone@bloomington.in.gov • 349-3738 Leslie Brinson.................................................... Community Events Manager brinsonl@bloomington.in.gov • 349-3715 Jaylynn Burney..................................................................... Program Specialist jaylynn.burney@bloomington.in.gov • 349-3783 Emily Carrico .....................................................Health/Wellness Coordinator emily.carrico@bloomington.in.gov • 349-3771 Hsiung Marler .........................................General Manager Switchyard Park marlerh@bloomington.in.gov • 349-3961 Sarah Mullin ...................................Community Events Program Specialist mullins@bloomington.in.gov • 349-3704 Haylie Pryson ................................................... Community Events Specialist haylie.pryson@bloomington.in.gov • 349-3773 Bill Ream.......................................................Community Events Coordinator reamw@bloomington.in.gov • 349-3748 Crystal Ritter................................................Community Events Coordinator ritterc@bloomington.in.gov • 349-3725 Amy Shrake.......................................................Program/Facility Coordinator shrakea@bloomington.in.gov • 349-3747 Maggie Tull......................................................... Switchyard Park Foreperson maggie.tull@bloomington.in.gov

Sports

Aaron Craig....................................................................Golf Facilities Manager craiga@bloomington.in.gov • 349-3791 Daren Eads........................................................................... Facility Coordinator eadsd@bloomington.in.gov • 349-3772 Dan Kluesner........................................Athletic Fields Working Foreperson 349-3760 Chris Lamb............................................Athletic Fields Working Foreperson Scott Pedersen .....................................................Sports/Facility Coordinator pederses@bloomington.in.gov • 349-3774 James Richardson ............................................ Golf Course Superintendent richarja@bloomington.in.gov • 349-3764 Brad Scroggins .....................................Master Motor Equipment Operator bradley.scroggins@bloomington.in.gov Jason Sims..............................................................Golf Programs Coordinator simsja@bloomington.in.gov • 349-3782 Megan Stark .............................................................Membership Coordinator starme@bloomington.in.gov • 349-3770 Mark Sterner...............................................................General Manager Sports sternerm@bloomington.in.gov • 349-3768 Dee Tuttle.................................................Sports Facility/Programs Manager tuttled@bloomington.in.gov • 349-3762