REGISTRATION

REGISTRATION DATES: Summer Classes & Programs April 26, Incorporated Danville residents May 3, Open registration PAYMENTS ACCEPTED: American Express, MasterCard, Visa, Discover, Exact Cash, Check or Money Order payable to Town of Danville

ONLINE REGISTRATION: www.danville.ca.gov/recguide

MAIL/DROP OFF: Danville Community Center • Click the blue Sign In button and Attn: Class Registrations log in with your email address. 420 Front Street • Select the Activities tab Danville, CA 94526 to filter your search. Hours: M–F, 8:30 am–5:00 pm • NEW account: click the Create an Account link (under the blue Sign In button), and follow the system prompts.

Please print and complete each line. A unique email address is required for each registrant 18 years of age and older.

Name (Parent or Guardian if under 18):__________________________________________ Home Phone: __________________________

Address: _____________________________________________________ City: _____________________________ Zip: _______________

Cell: ____________________________ Email (required): ___________________________________________________________________

REGISTRATION FORM IS LIMITED TO FAMILY MEMBERS ONLY. Check one: o Resident o Non-Resident (for clarification, see page 46.) o Please check if you have changed your address from last registration. o To assure our programs benefit all who attend, please check here if any participant has a disability requiring special accommodations.

Participant’s Name Birthdate Activity # 2nd Choice Class Title Activity # Fee

I have read and understand the refund policy. Waiver of Liability: I, the undersigned or parent/legal guardian of the individual named above, do hereby waive, release, and discharge all claims for damages, death, personal injury, property damage which I may have or which may hereafter accrue to me as a result of participation in said activity. I understand that accidents can occur during the said activity. Knowing the risks of the said activity, I hereby agree to assume those risks. This release is intended to discharge and hold harmless the Town of Danville, its officers and employees from liability. This waiver and assumption of risk is to be binding on my heirs and assigns. I further understand that photographs and video may be taken of me during the course of the said activity and that these photographs and video may be used for Town of Danville publicity purposes. I HAVE READ AND UNDERSTAND THIS RELEASE. Please read refund policy before submitting your registration.

__________________________________________________________ _____________________ Signature Required (o parent) (o guardian) (o participant) Date

PAYMENT METHOD

Mail registration form & payment to: Danville Community Center, Attn: Class Registrations 420 Front Street, Danville, CA 94526

Payment by check or money order made payable to “Town of Danville”: o Check *Credit Card: o MasterCard o Visa o American Express o Discover o Card on File TOTAL: ______________________

Credit Card No: ____________ –____________ –____________ –____________ Exp. Date: _____________ 3- or 4-digit verification code: _____

Signature:________________________________________________________________________ Payments made by credit card are subject to a 2.99% credit card processing fee.