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I understand that the North Riverside Recreation Department and all employees working for the Department and the Village
are not liable for any accidents or injuries incurred. By partaking of classes, in or out of town, or on trips, I assume all
responsibility in case of injury and financial liability for medical expenses. By partaking in any recreation program, I
release, waive, absolve, and indemnify the above from any financial responsibilities. It is recommended that the participant
review his/her own personal insurance policy for adequate coverage during all program activities. I hereby consent to the
use of my photograph in the North Riverside Recreation brochures, publications, slide presentations, etc.
I further agree to abide by all policies and procedures set forth by the Recreation Department in the Day Camp Parent
Manual as well as the Day Camp Behavioral Guidelines. I have read and understand the parent manual and agree to follow
all policies and procedures set forth in the manual.
Medical Release: In the event that no one can be reached, I hereby give my permission for my child to receive necessary
emergency transportation and/or treatment. I agree to the emergency transportation notice on the reverse side of this form.
Refund and Cancellation/Transfer Policy: Refunds for Camp will be issued only if a replacement person is found and
enrolled. Spaces cannot be held. A $10 fee will be assessed for transfers.
I, as the signee/authorized guardian, agree to all aforementioned information.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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Village of North Riverside2401 S Des Plaines AvenueNorth Riverside, IL 60546Phone: 708-447-4211