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For Your Information

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PARTICIPANT REGISTRATION FORM
Complete and submit this form to sign up for activities. After you submit it,
you must also print, sign, and return the WAIVER form to complete the process.


Pre-registration is required for all activities. Registration deadlines are three days before activity begins unless otherwise stated. Late registrations are possible only when there are openings and late fees may apply.

The Louisa County Department of Parks and Recreation does not provide medical coverage or insurance for individual participants. All medical insurance protection must be provided by the parents or participant. In the event of an emergency, I hereby give my consent for the program supervisor of the Parks and Recreation Department to arrange for medical treatment or Emergency Room treatment by a physician on staff. I also hereby give my consent and approval for my son/daughter/self to participate in this activity sponsored by the Louisa County Department of Parks and Recreation. I will not hold Department Personnel, Instructors, School Personnel, or Volunteers responsible in case of accident or injury as a result of my/my child's participation in this program. I understand the risks involved with this activity and know that my child is/I am physically able to participate in this program.


PARTICIPANT REGISTRATION FORM
Parent/Guardian/Participant Name:
Mailing Address:
City and State:
Zip Code:
E-Mail Address:
Home Phone:
Work Phone:
 
Participant 1 First/Last Name: /       M F
Birthdate (mm/dd/yy):       T-Shirt size if applic:
 
(Youth S M L, Adult S M L X)
School Attends:       Grade:
Program Name:       Starts:       Fee:
 
Participant 2 First/Last Name: /       M F
Birthdate (mm/dd/yy):       T-Shirt size if applic:
 
(Youth S M L, Adult S M L X)
School Attends:       Grade:
Program Name:       Starts:       Fee:
 
Participant 3 First/Last Name: /       M F
Birthdate (mm/dd/yy):       T-Shirt size if applic:
 
(Youth S M L, Adult S M L X)
School Attends:       Grade:
Program Name:       Starts:       Fee: