Senior Guide_Winter Spring 2020

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Creating ACTIVE Retirement Years (919) 469-4081 59 Registration Form Registration Dates: December 3 (Cary Resident) December 17 (Non Resident) Mark Your Calendars! Registration Form Mailing Address: Cary Senior Center • P.O. Box 8005 • Cary, NC 27512-8005 Participant's Last Name _________________________________ First Name ____________________________________ Mailing Address ______________________________________________________________________________ City ____________________________________ ST ____________________ ZIP _________________________ Home Phone ________________________________ *E-mail Address _______________________________ How do you prefer to receive your registration receipt? q Email q Printed/Mailed Valid email address required. *By providing my e-mail address I agree to receive e-mail communication from Town of Cary. Work or Cell Phone __________________________ Date of Birth _________________________ (required) Local Emergency Contact Name: ______________________________________________________ (required) Local Emergency Relationship: ________________________________________________________ (required) Local Emergency Contact Phone Number: _____________________________________________ (required) Are you a Cary Resident? q Yes q No Gender: q Female q Male Class Code Class/Workshop Title Day Date(s) Time Fee* _______________ _____________________________ __________ ________ ________ ______________ _______________ _____________________________ __________ ________ ________ ______________ _______________ _____________________________ __________ ________ ________ ______________ The Town of Cary provides the opportunity for Cary residents to apply for scholarships and/or reduction of fees for Parks, Recreation & Cultural Resources' programs. If you are interested in donating $1 or more to the scholarship fund, please indicate it in the total on your registration form and include it in your check. Thank you ! MAKE CHECKS PAYABLE TO "Town of Cary" Scholarship Donation: $ ________________ I would like to donate $1 or more to the scholarship fund. Total from other side: $ ________________ See registration information for more details. Total from this side: $ ________________ *Nonresident, pay fee indicated in program description. Total Amount Due: $ ________________ Programs are provided for people of all abilities. If you need a reasonable modification, please check YES below and complete the registration at least two weeks prior to the start date of the program/class. Each request will be assessed in compliance with the ADA. q YES WAIVER I, for myself or as parent or guardian, hereby assume all the risks and hazards incidental to the conduct of the activities and transportation to and from the activities. I release, absolve, and indemnify the Town of Cary, employees of the Town, volunteers, contractors and/or sponsors from all risks and hazards associated with the activities and in the event of injury, do expressly waive all claims against them. I understand that no insurance coverage is provided by the Town of Cary Parks, Recreation and Cultural Resources Department. By registering for this program, I understand and agree that if a portion of the program is unable to be completed due to inclement weather or other unforeseen circumstances, I will receive a prorated credit on my account for the uncompleted portion of the program. Further, I understand and agree that I have up to one year to use the credit and if it is not used within the one year, the credit will be donated on my behalf to the PRCR Scholarship Fund. Signature:___________________________________ Date:________________ WAIVER MUST BE SIGNED Registration Dates: August 4 (Cary Resident – EZ Reg Web, EZ Reg Mail-In, EZ Reg Phone) August 18 (Non Resident – Any EZ Reg Method) Mark Your Calendars! Additional space for more classes on the back >>> (Subject to Public Records Law)

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