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<br />Attachment B <br /> <br />Sample Registration Card <br /> <br />(S"x?" index card, front) <br /> <br />Facility Name <br />Parks and Recreation Department <br />City/ Town of <br /> <br />Applicant Information (please print) <br /> <br />Name: <br /> <br />Address: <br /> <br />City/Town: <br /> <br />State/ Zip: <br /> <br />Home phone: <br /> <br />Emergency contact: <br /> <br />Phone: <br /> <br />(S"x?" index card, back) <br /> <br />I/we are aware of the nature of the skateboard/in-line skating activities available throughout the <br />Parks and Recreation Department. I/we hereby give permission for my/our child to participate. <br /> <br />I/we release the city/town of and its employees and agents from any <br />liability for injuries that may arise out of my/our child's participation in these skateboard/in-line <br />skating activities. <br /> <br />Parent/Guardian Signature: <br /> <br />Date: <br /> <br />Participate Signature: <br /> <br />Date: <br /> <br />Recreation Department <br />Representative Signature: <br /> <br />Date: <br /> <br />10 <br />