Type Full Name :
Sign With Hand
Address
Step 2: Select an Activity
Balance Remaining
Relationship to Participant
First Name
, agree to the waiver and release of liability stated below:
City
ZIP
Phone #
Location
Last Name
Other
Signature
Participant's Phone #
Activity Category
Relationship Other
Step 1: Complete Applicant Information
Please Note: the Participant's Age must be within the allowed Age Bracket for the Activity selected.
End Date
Type your Activity OR click the Magnifying glass to pull up the entire list of Activities.
Last Name
Parks & Recreation
Activity Registration
I,
Details
Grade in the Fall
Step 3: Participant Information
Email Address
Age Brackets
Relationship to the Participant
Please review your application before signing and submitting for payment.
Questions? Call Parks and Recreation Director Lynda Kasik at 815-488-1395 or email l.kasik@lasalle-il.gov
Activity Name
Are you a resident or non-resident?
Phone #
Step 6: Payment
Shirt Size
Amount Due
Step 5: Waiver and Release of Liability
First Name
Parent/Guardian Last Name
Start Date
Date of Birth
Phone # During Camp/Activites
Phone # to Schedule Changes Before Camp
Instructor
Step 4: Emergency Contact information DURING camps/activities
State
Participant Age

GENERAL WAIVER, RELEASE OF LIABILITY, ACKOWLEDGEMENT OF AND ASSUMPTION OF RISKS REGARDING ANY AND ALL CITY OF LA SALLE PARKS AND RECREATION DEPARTMENT ACTIVITIES
PLEASE READ BEFORE SIGNING
In consideration of being allowed to participate in any way in any City of La Salle recreational activities including, but not limited to any activity with the City of LaSalle Parks and Recreation programs, related events, activities, and each of them the undersigned acknowledges, appreciates the risks involved in connection therewith, and agrees as follows:

    1. I am aware that the activities involved in this program are potentially hazardous and that I should not participate unless medically able and do hereby affirm that I am medically able.
    2. I understand that the risks involved include potential significant physical injury including potential paralysis, and even death, amongst other potential injuries and conditions of ill-being that I might suffer.
    3. I knowingly and freely assume any and all such risks, both known and unknown, even if arising from the negligence and/or other fault of the parties being released and each of them, and I additionally assume full responsibility for my participation in any such activities.
    4. I additionally willingly agree to comply with any stated and/or customary terms and conditions related to these activities and my participation. Also, in the event I observe any unusual, significant hazard during my presence or participation, I agree to remove myself from participation and also to bring such to the attention of the nearest official immediately; and
    5. Additionally, I for myself, and my heirs, assigns, personal representatives, and/or next of kin hereby release and totally discharge the City of LaSalle, their directors, officers, officials, agents, volunteers, and/or employees, other participants, supporting agencies, sponsors, advertisers and if applicable owners and/or lessors of premises used to conduct the event, and each of them (“releasees”) from and/or with respect to any or all claims, demands, causes of action, and/or damages of any kind or nature also related in any manner whatsoever to any injury, disability, death, loss and/or other damage to person or property, whether arising from the negligence and/or other fault of the releasees, or any of them, or otherwise to the fullest extent permitted by law. I also agree and acknowledge that in the event that any provision hereof and/or a portion of any provision should be declared invalid and/or unenforceable for any reason, that the invalidity of any such provision and/or portion thereof shall not affect the validity and/or enforceability of any other provision.

I have read this waiver, release of liability, and agree to undertake and assume all risks as provided herein, I further fully understand the terms, understand that I may be giving up substantial rights by signing this document, and sign this document freely and voluntarily without any inducement.

Parent/Guardian First Name