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Senior Guide_Fall 2017

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Maili n g A d dress: P. O. B ox 8005, Cary, N. C. 27512 5 5 Re gistrati o n For m Registration Dates: August 7 (Cary Resident – EZ Reg Web, EZ Reg Mail-In, EZ Reg Phone) August 21 ( Non Resident – Any EZ Reg Method) Mark Your Calendars! Mailin g A d dress: Cary Seni or Center • P. O. B ox 8005 • Cary, N C 27512-8005 Partici pant's Last Na me _________________________________ First Na me ____________________________________ Mailin g A d dress ______________________________________________________________________________ City ____________________________________ ST ____________________ ZI P _________________________ H o me Ph one ________________________________ *E- mail A d dress _______________________________ Ho w do you prefer to receive your re gistration recei pt? q E mail q Printe d/ Maile d Vali d e mail a d dress re quire d. * By provi din g my e- mail a d dress I a gree to receive e- mail co m munication fro m To wn of Cary. Work or Cell Ph one __________________________ Date of Birth _________________________ (re quire d) L ocal E mer gency C ontact Na me: ______________________________________________________ (re quire d) L ocal E mer gency Relati onshi p: ________________________________________________________ (re quire d) L ocal E mer gency C ontact Ph one Nu m ber: _____________________________________________ (re quire d) Are you a Cary Resident? q Yes q No Gender: q Fe male q Male Class Code Class/ Workshop Title Day Date(s) Ti me Fee* _______________ _____________________________ __________ ________ ________ ______________ _______________ _____________________________ __________ ________ ________ ______________ _______________ _____________________________ __________ ________ ________ ______________ The To wn of Cary provi des the o p portunity for Cary resi dents to a p ply for scholarshi ps an d/or re duction of fees for Parks, Recreation & Cultural Resources' progra ms. If you are intereste d in donatin g $1 or more to the scholarshi p fun d, please in dicate it in the total on your re gistration for m an d inclu de it in your check. Thank you ! M AKE C HECKS PAYA BLE T O "To wn of Cary" Scholarship Donation: $ ________________ I would like to donate $1 or more to the scholarship fund. Total fro m other side: $ ________________ See registration infor mation for more details. Total fro m this side: $ ________________ * Nonresident, pay fee indicated in progra m description. Total A mount Due: $ ________________ Pro gra ms are provi de d for peo ple of all a bilities. If you nee d a reasona ble mo diication, please check YES belo w an d co m plete the re gistration at least t wo weeks prior to the start date of the pro gra m/class. Each re quest will be assesse d in co m pliance with the A D A. q Y ES WAIVER I, for myself or as parent or guardian, hereby assu me all the risks and hazards incidental to the conduct of the activities and transportation to and fro m the activities. I release, absolve, and inde mnify the To wn of Cary, e mployees of the To wn, volunteers, contractors and/or sponsors fro m all risks and hazards associated with the activities and in the event of injury, do expressly waive all clai ms against the m. I understand that no insurance coverage is provided by the To wn of Cary Parks, Recreation and Cultural Resources Depart ment. By registering for this progra m, I understand and agree that if a portion of the progra m is unable to be co mpleted due to incle ment weather or other unforeseen circu mstances, I will receive a prorated credit on my account for the unco mpleted portion of the progra m. 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 M UST BE SI G NE D 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 >>> Additional space for more classes on the back >>> Additional space for more classes on the back >>> Additional space for more classes on the back >>> (Su bject to Pu blic Rec or ds La w)

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