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Please circle your activity for registration: Fall Break Camp

(only one activity per registration sheet) Outdoor Soccer Flag Football 1st & 2nd Grade 5-7 years old 3rd & 4th Grade 8-12 years old 5th & 6th Grade Indoor Soccer

Pre-K (ages 3-4) Kindergarten 1st-2nd Grade

Jr.Jazz Kindergarten 1st-2nd Grade 3rd-4th Grade 5th-6th Grade

1st-2nd Grade 3rd-4th Grade

Pre-K (ages 3-4) Kindergarten

3rd-4th Grade 5th-6th Grade

Jr. Jazz Camp Kindergarten 1st-2nd Grade

I would like to coach: (Volunteer forms must be filled out at time of registration)

NAME:_________________________ ) ______________ Phone # ( Best Email Address______________________________

(Please write clearly) Name of Participant________________________________________

Birth date____________________ Age________ Girl _____Boy____ Address_________________________________________________ City__________________________ State___________ Zip_______ School Attending____________________ Grade (as of Sept. 1)______ Parent or Guardian_________________________________________

) ___________________

Best Email Address_________________________________________ Best Phone # (

) ___________________

Emergency Contact (other than guardian) _______________________________________________________ Phone # (

I would like to be placed on the same team as _______________________________________________________

Parental Statement of Agreement – Assumption of Risk, Liability Release, Indemnification and Refund Policy 1. Release and Indemnification: I hereby recognize and acknowledge that my child’s participation in recreational activities may involve bodily injury and/or emotional injury to myself and/or my child. In consideration of my child being permitted to participate in such events, I for myself, my child, my heirs, my executors and administrators, herby voluntarily and knowingly indemnify and hold harmless, defend, release, waive, and discharge Salt Lake County, and its officers, employees and volunteers from any and all suits, claims or liability, including negligence, based on any injury except that caused solely by the willful misconduct of Salt Lake County, that may result from my child’s participation in Salt Lake County Parks & Recreation activities. In addition, I agree that I or my insurance company will pay for medical, hospitalization or any other expenses resulting from my child’s participation. 2. Refund Policy: As per Salt Lake County policy and procedures, the Parks & Recreation Division may withhold 25% of the refund (program registration fee) for administrative costs. All refunds must be requested in person, accompanied with a written refund request. No refunds shall be given after the first day of the program. 3. Collections: I agree to pay Salt Lake County all costs incurred together with reasonable attorney’s fees in the event that my account is referred to the Salt Lake County Attorney’s Office for collection. I understand that any account delinquent 30 days or more will be turned over to the Salt Lake County Attorney for collection. 4. Emergency Treatment: I hereby authorize Salt Lake County Parks and Recreation program staff to act on my behalf in accordance with their best judgment in case of an emergency involving my child, and agree to assume full responsibility for all expenses, medical or otherwise, that may arise there from. I understand that I or my insurance company will pay for such emergency treatment. 5. Equal Opportunity: Salt Lake County Parks and Recreation provides equal opportunity to participate regardless of race, creed, gender, or ability to pay, and will, upon request, provide reasonable accommodations to individuals with disabilities. 6. By signing this assumption of risk, liability release, indemnification and refund policy statement, I acknowledge that I have read its contents and disclosure, that I understand its contents and disclosure, and that I agree to its terms.

Signature (if under 18 Parent or Legal Guardian) _______________________________________________________Date________________


Copperview Recreation Center Where:

Lunch WILL NOT be provided! AM & PM Snacks will be provided.

Swimming Field Trip (on Friday), Sports and Fitness, Arts and crafts, Games, and lots of other fun activities


Register Early—Space is limited!


Themed adventure camp for children ages 5-12


Canyons School District Fall Recess— Thursday Oct. 18th & Friday Oct. 19th


Drop-off 9:00a.m.—Pick-up no later then 12:00p.m.


TBA –Scholarships will be available

Copperview Recreation Center also offers a wide range of classes that provide many opportunities for the kids in our community, including:

OFFICE USE ONLY…Receipt No. __________ Amt. $_________ Recv’d. by ________ Date: _____ Head Injury Waiver _______ Code of Conduct _________ Info. Sheet ________

Kid Sport Kids in the Kitchen Ski & Snowboard Gymnastics Aikido Tae Kwon Do Theatre Ballet        

$25 ($15 if you qualify for free/reduced lunch) Fee:

Drop-off 8:00a.m.—Pick-up no later then 6:00 p.m. ($5 late pick-up fee will be enforced after 6pm) Times:

Copperview Recreation Center Where:

Canyons School District Fall Recess— Thursday Oct. 18th & Friday Oct. 19th When:

For children ages 5-12 Who:

What: Indoor soccer recreational program that uses walls and teaches soccer skills, teamwork, and to have fun! Who:

Boys and Girls PreK (3-4 year olds) thru 4th Grade

Where: Copperview Rec. Center


Outdoor recreation soccer program where fun & skills are the main focus.


Boys and Girls 3 years thru 6th grade


All Games played @ Copperview Rec. Center


Program includes: 6 games, Jersey, and participation award Cost: $20 ($15 if qualified for free/reduced lunch)

Games are played Tuesday Nights and Saturday Mornings. Organization Day is Saturday, September 15th at Copperview Rec. Center

Program includes: Uniform, 6-games & participation award Cost:

When: 3rd/4th Grade league will play Tuesday evenings and Saturday Mornings. PreK-2nd Grade will play Thursday evenings and Saturday Mornings

$27 full fee *$22 Free/Reduced Lunch *Proof MUST be brought in at time of registration

4-Week Pre-season Camp Starts Dec.1st

For grades K-4th Kids will learn basic basketball fundamentals to prepare them for the Jr. Jazz regular season.

Cost: $10

Jr. Jazz Regular Season Who:

Boys and Girls Coed teams - Kindergarten thru 6th


Where: All games will be played @ Copperview Rec. Center starting Jan. 11

For ages 6-12 kids will learn basic skills getting them ready for flag football


September 8th @ 9:30AM


Non-contact recreational flag football league designed to teach fundamental skills, teamwork, fair play, and fun!


Boys and Girls Co-ed League 1st-6th Grade


Games will be Tuesday Night (3rd-4th Grade) Wednesday Night (1st-2nd Grade) Thursday Night (5th-6th Grade)

All games will be played on Saturdays (times will vary by age group) Program includes: 6 games, Jersey, and participation award Cost: $35 ($30 if qualified for free/reduced lunch)

Program includes: 6 games, Jersey, and participation award Cost:

$25 ($15 if you qualify for free/reduced lunch)

Become a SL County Certified Coach to receive $25 Discount for coaching For more information please visit our website click on Youth Sports

8446 S. Harrison St. (300 W.) Midvale, Ut. 84047 (801) 559-1500 new phone # as of 9/1 385-468-1515

2012 Fall Brochure  

2012 Fall Brochure