City of Laguna Niguel Contact Information:CITCITY MEETINGY MEETINGS S Get outside and tGet outside and takake a e a Parks and Recreation DepartmentCrown Valley Park & E& EVENTVENTSS REGISTRATION FORM29751 Crown Valley Parkway hikhike te this Fhis Fall! all! Laguna Niguel, CA 92677 SEPTEMBER 2023 ONE FORM PER PERSON REQUIRED(949) 425-5100 [email protected] TUES WED THUR FRI SAT 1 2 PARTICIPANT’S NAME: _____________________________________________________ SEX ____ D.O.B_____/_____/_____ GRADE ________ 3 4 5 6 7 8 9 PARENT/GUARDIAN NAME (if participant is a minor): __________________________________________________________________________ ADDRESS _______________________________________________________________ CITY _______________________ ZIP ______________10111213141516 HOME PHONE ( _____ ) ______ - __________ WORK PHONE ( _____ ) ______ - _________ CELL PHONE ( _____ ) ______ - ___________ 17181920212223 EMAIL ADDRESS __________________________________________________________@ ___________________________________________2430 24 25 26 27 28 29 EMERGENCY CONTACT (other than parent) _______________________________________________ PHONE ( _____ ) ______ - ___________ MEDICAL INFORMATION ________________________________________________________________________________________________OCTOBER 2023 If you need special assistance, please contact the Parks and Recreation Department at least one week prior to the start of activity.SUNMON TUES WED THURFRISAT 1 2 3 4 5 6 7 ACTIVITY #NAME OF ACTIVITYDAY/TIMECHECK # FEE 8 9 10 11 12 13 14 15 16 17 18 19 20 21 The Fall is a perfect time to enjoy the City’s 80 22 23 24 25 26 27 28 miles of trails. Enjoy beautiful views and walks 29 30 31 throughout the City. Our trails range from 昀氀at paths, winding hills, ridges overlooking the I voluntarily agree to have myself or my child participate and I realize that every precaution is taken to eliminate any injury or hazards to myself or my child, and that NOVEMBER 2023ocean, and even a walk through the Laguna a competent supervisor is present; however, in the event of any injury to myself or my child, I hereby waive, release and hold harmless from any liability for damages SUNMON TUESWED THURFRISATNiguel Regional Park. or claims for damages for personal injury, including accidental death, as well as from claims for personal property damage which may arise in connection with the program, against the City of Laguna Niguel and all it’s o昀케cers, agents and employees.1234 I give consent to any X-Ray examination, anesthetic, medical or surgical diagnosis tendered under the general or special supervisor of any member of the medical Stop by any City facility to pick up a trail map sta昀昀 and emergency room sta昀昀 licensed under the Medicine Practice Act or a dentist licensed under the Dental Practice Act or the sta昀昀 of any acute General hospital 567891011or check it out online at cityo昀氀agunaniguel. holding a license to operate from the California Department of Public Health. It is understood that this authorization is given in advance of diagnosis, treatments, or org/trails. For questions and more information, hospital care being required but is given to provide the aforementioned medical/dental personnel authority to render care as they deem advisable. It is understood 12131415161718 that e昀昀orts shall be made to contact the undersigned prior to rendering treatment, but that treatment will not be withheld if the undersigned cannot be reached.please call us at (949) 425-5100. I permit the use of activity/event photography and/or video of my child or myself for LN Parks & Recreation media promotion.19202122232425 I HAVE READ AND UNDERSTAND THIS RELEASE FROM LIABILITY AND THE CANCELATION/REFUND POLICY. 2627282930 ________________________________________________________________________________ Date _________/_________/_________ (Signature) Parent or Guardian must sign for those under 18 years of ageCITY MEETINGS SPECIAL EVENTS PAYMENT INFORMATION: CITY OFFICES CLOSED ■ NAME ON CARD_____________________________________________________________________________________________________Calendar subject to change. Visit CityofLagunaNiguel.org/Recreation CREDIT CARD NUMBER __________________________________________________________ EXP DATE _________/_________/_________ 3-DIGIT CVC CODE ______________ 32