OCC Activity Registration Form - Please Print and Fill Out Completely
Household ID#
Adult Parent
Or Guardian
Last Name
First Name
MI
Address
City
State
Zip
E Mail
Phone Numbers
Home
Cell
Work
Emergency
Activity
Number
Start
Mo./Day
Participant’s Name Birth Date
M / D / Y
Sex Activity Name
& Starting Time
Fees
Last First
/ / /
/ / /
/ / /
/ / /
/ / /
/ / /
Shirt Sizes if applicable
Form of Payment: Cash (Do not mail cash) Check (Visa/Mastercard only accepted in person at the OCC )
Are you an Oakwood resident? Yes No Are you an OCC member? Yes No Total Amt Enclosed $
Waiver for Participant and/by Parent
In consideration of your accepting my or my child’s entry, I hereby, for myself, my child, my heirs, executors, and administrators, waive and release any and all rights and claims for damages I or my child may have against the City of Oakwood and its representatives, successors and assigns for any and all injuries suffered by myself or my child on any activity sponsored by these groups. I do hereby grant and give these groups the right to use my or my child’s photograph or image with or without my child’s name both single and in con- junction with other persons or objects for any and all purposes including, but not limited to private or public presentations, advertising, publicity and promotion relating thereto. I warrant that I have the right to authorize the foregoing uses and do hereby agree to hold the City of Oakwood Leisure Services Department harmless of and from any and all liability of whatever nature which may arise out of result from such uses. For the consideration stated above, I further agree that in the event that my child repudiates or attempts to repudi- ate such release, I will personally indemnify and save harmless the City of Oakwood Leisure Services Department, its successors and assigns, for any and all loss and damage occa- sioned thereby.