Health & Fitness
Registration REGISTRATION FORM
Registration begins May 5
PERSON RESPONSIBLE FOR THE ACCOUNT TEL (HOME) TEL (CELL/WORK) ADDRESS CITY STATE ZIP EMAIL ADDRESS 1ST CHOICE PARTICIPANT NAME
M/F
DOB
ACTIVITY NAME
ACCOUNT #
CLASS #
START DATE
2ND CHOICE CLASS #
START DATE
EXP DATE
FEE
TOTAL
AUTHORIZATION SIGNATURE WAIVER OF LIABILITY I consent to the above person’s participation in the activities and agree on behalf of myself, or minor child, that I assume the risk of accident, injuries or property damage sustained from any cause in connection with my (or my child’s) participation in the activities. I voluntarily release and hold harmless the City (including its officers, agents, employees and volunteers) from any liability for an accident, injury or property damage (except to the extent cause by the City’s active negligence or willful misconduct). I understand that I am responsible for the registration policies and procedures outlined in the brochure. I also understand that the City reserves the right to photograph activities and participants; those photos remain the City’s property for potential future use for publicity or promotional purposes. Dated
Signature
Please indicate whether: Parent
Participant
Guardian
policies RefundS/creditS
• All credits on account are valid
• Lab fees are payable to the
with disabilities to participate in
• Refunds/credits are subject to a
for a maximum of one year.
instructor at the first class. Please
our programs. If you have any spe-
service charge of $10 per person,
• Failure to attend program or
do not include lab fees with your
cial needs that may require specific
per class. Refunds are processed
“no-shows” will not be granted a
registration fees.
accommodations, please call (925)
within three weeks.
refund/credit.
• Accounts with credit amounts un-
943-5858.
• Refunds will be considered if
• Refund policies may vary for 50+
der $15 that are eligible for refund
requests are submitted up to seven
(Seniors) programs.
will be remitted upon request.
days prior to the first day of class.
fees
• For payment plans (annual
• For withdrawal requests received
•All courses and camp registra-
programs, camps, etc.), customers
after the refund period but prior to
tions include a $3 administrative
must provide a MasterCard or VISA
the first day of class, a credit valid
processing fee.
for automatic payment processing.
for one year may be permitted for
• Fees must be paid in full at time
In order to use a different method
use toward a future course.
of registration by cash, money
of payment, customers may pay
• Withdrawal requests after the first
order, VISA, MasterCard or check
prior to any scheduled payment
class meeting are subject to partial
payable to the City of Walnut
date(s).
credit less service charge and pro-
Creek, unless otherwise stated in
rated course fees.
program description.
• No refund requests are accepted
• All payments are processed upon
after the last class meeting.
receipt.
Waiting lists
CANCELLATIONs
MAKE -UP CLASSes
QUESTIONS
Waiting lists are established once a class has reached maximum enrollment. If space opens or a new class is created, you will be notified.
A class may be cancelled if minimum enrollment is not met. A full refund is available.
Make-up dates for missed classes will only be granted for class cancellations resulting from inclement weather or from direction of the Arts, Recreation & Community Services Department.
Arts: (925) 943-5846 Rec: (925) 943-5858 Aquatics: (925) 943-5856 50+: (925) 943-5851 Specialized Recreation: (925) 256-3531
ADA Accommodations In compliance with the Americans with Disabilities Act (ADA), the City of Walnut Creek encourages those
donations If you wish to make a tax-deductible donation to Civic Arts Education or Walnut Creek Recreation, please indicate so on your registration form. Thank you! SCHOLARSHIPS Civc Arts Education Scholarships are being accepted for Summer 2014. The deadline is June 2, 2014. Walnut Creek Recreation scholarships are accepted on an on-going basis.
www.Arts-Ed.org | (925)943-5846
81