Youth Center Registration Form

Child Information
Name of Child * Required
First Last
Gender * Required
- Boy
- Girl
Birth Date * Required
Month
Day
Year
Age of child * Required
Grade * Required
Name of School * Required
Parent / Guardian Contact Information
Parent name * Required
First Last Suffix
Phone * Required
Parent email * Required
Disclaimer
Consent * Required
By enrolling my child in Palmview Parks & Rec Activity/Sport I understand that while participating in activities or using Palmview Parks & Rec facilities that he/she does at his/her own risk. Palmview Parks & Rec, its director, staff and agents shall not be liable for any damage whatsoever arising from any personal injury or property loss sustained by participant with his/her own family in or about any programs on the premises. Participants and parents assume full responsibility for all injuries and damages which occur in or about any programs on the premises. I therefore release all rights or claims for damages against the City of Palmview Parks & Rec department and all individuals assisting in instruction or conducting these activities. Palmview Parks & Rec reserves the right to withhold our services to any participant that may cause problems during activities or any other person that may be a point of conflict to the Palmview Parks & Rec. I further understand that there is NO REFUND/ NO EXCEPTIONS should my child voluntarily resign from the programs/ activities provided by the Palmview Parks & Rec.
I agree to this policy.
Signature * Required
Signature of parent or guardian
Payment
Registration fee * Required
Price:
3.5% + $0.35 convenience fee * Required
Price: $0.00
Total
$0.00
Credit Card
Card Details
Cardholder Name
Billing address * Required
Street Address Address Line 2 City State ZIP Code
Comments
This field is for validation purposes and should be left unchanged.

Youth Center Registration Form

Child Information

Parent / Guardian Contact Information

Disclaimer

Payment