Park & Recreation Summer Classes - City of Wichita

REGISTRATION
REGISTRATION FORM
Please check here if your address has changed in the last 12 months
Office Use only
CA CK MC VS
Date Received:
Botanica’s Downing
Children’s Garden
Parent/Guardian Name (if enrolling a child)
Adult Birth Date
Street City Zip
Home Phone Cell Phone Work Phone
Email
Code Location Class Name Day Time Participant Name Gender Birth Date Fee
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children and their families can explore, interact
and discover nature, art, and music all at once. By
visiting the Children’s Garden children can develop
a connection with nature, the arts, science and an
Children’s Garden features an array of fun, interactive
areas, including:
Cargill Children’s Farm
The Monster Woods
Granny Jean’s Tree & Treehouse
Salamander Spring & Stream
The Fossil Wall
Granddaddy’s Musical Maze
Polliwog Pond
I agree to release, indemnify, and hold the City of Wichita, its agents, officers and employees (City) harmless from any and all liability claims, actions, judgments, damages or injuries of
every kind and nature whatsoever to myself, the participant(s) I am authorizing, and/or his or her property, when that damage or injury arises from participation in activities for which the
participant is registered. I further acknowledge that I have familiarized myself with the description of the activities, understand the hazards and the participant’s personal
limitations and knowingly assume all risks. I acknowledge I have read and understand this Liability Waiver, Release and Indemnity Agreement, and understand that I am waiving any
claim that may arise against the City for any harm sustained as a result of any activity for which I am registering or for which I am registering a minor child.
Signature of Participant Date Signature of Responsible Adults Date
(If Participant is Under 18 years old)
For publicity purposes I give permission to use a photo of people I am registering.
Initial
The City of Wichita prohibits discrimination on the basis of race, ethnicity, national origin, sex, religion, age, sexual orientation, or disability in its services, programs and activities.
Anyone who believes he or she has been discriminated against may file a complaint with the City of Wichita Equal Affirmative Action Administrator in the Personnel Division at 268-4351. The City of Wichita does not
carry accident insurance to cover participants. Involvement in any activity is done at the participant’s own risk.
701 N Amidon Ave | botanica.org
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Register NOW Online—wichita.gov Classes Start June 3 Call 316.268.4361
facebook.com/WichitaParkandRec
wichita.gov
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