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(Please write clearly)

8446 S. Harrison St. (300 W.) Midvale, UT 84047 (801) 559-1500

Refund Policy: As per Salt Lake County policy and procedures, the Parks & Recreation Division may withhold 25% of the refund (program registration fee) for adminis-

OFFICE USE ONLY…Receipt No. __________ Amt. $_________ Recv’d. by ________ Date__________ Code of Conduct _________ Information Sheet ________

Signature (if under 18 Parent or Legal Guardian) _______________________________________________________Date________________

derstand its contents and disclosure, and that I agree to its terms.

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 un-

request, provide reasonable accommodations to individuals with disabilities.

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

company will pay for such emergency treatment.

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

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

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.

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

trative 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.

2.

participation.

es resulting 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 expens-

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

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

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,

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

Parental Statement of Agreement – Assumption of Risk, Liability Release, Indemnification and Refund Policy

I would like to be placed on the same team as______________________________________________________

Emergency Contact (other than guardian)______________________________Phone_______________

Home Phone___________________CellPhone___________________

Parent or Guardian____________________________ Best Email Address________________________________

School Attending____________________________________________Grade__________

Address___________________________________City________________State___________Zip__________

Name of Participant___________________________Birth date_________Age________ Girl _____Boy____

Copperview Recreation Center


Program includes: Hat, shirt, 8 games, participation award, and 2 bees ticket vouchers

$55

Cost: $31

ACTIVITIES WILL INCLUDE: Swimming Field Trip, Sports and Fitness, Arts and crafts, Games, and lots of other fun activities!

You must register in advance! Space is limited!

Katniss’ Challenge: Survivor Camp What: Taken from the story of the “Hunger Games’”, this camp will teach you everything from strategy to outdoor survivial. Come join other youth and have a BLAST learning about animal tracks, building shelters, geochaching & more! All while competing with other “districts” in a fun & exciting adventure. Who: Boys and Girls, 4th– 7th Grade Where: Copperview Rec. Center

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

Boys and Girls Pre-K thru 6th grades (5th and 6th grades will be a traveling team with in Midvale and Sandy)

Where: Midvale City Park/ Copperview Elem./ Copperview Recreation Center When: PreK thru 2nd grade Wednesday evenings & Saturday mornings. 3rd thru 6 grades Tuesday evenings & Saturdays

Organization Day is April 14th

Cost: $75

Cost:

$36 full fee (Prek-2nd) $41*(3-6 grades)

SIGN UP EARLY! SPACE IS LIMITIED

Become a SL County Certified Coach to receive$25 Discount For more information please visit our website www.recreation.slco.org/copperview click on Youth Sports or call the coordinator @ (801) 559-1500

Spring Break Camp Survivor Camp

Program includes: Full Uniform (jersey, shorts, socks) 8-games & participation award

□ 5-9 years old □ 8-10 years old □ 8-12 years old □ 11-13 years old

When: Monday April 2nd- Friday April 9th, 9:00am—12:00pm

(only one activity per registration sheet)

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

I am signing my child up for:

Fee:

Games will be played Saturdays from 9:00AM-3:00PM

Tee Ball/Coach Pitch

Times: Drop-off 8:15 a.m.—Pick-up no later then 6:00 p.m. ($5 late pick-up fee will be enforced after 6pm)

Soccer

When: Starts Monday April 2nd—Ends Friday April 6th

□ Tee Ball (ages 3-5) □ Coach Pitch(ages 6-8)

Boys and Girls, ages 5-12 years old

□ Pre-K (ages 3-4) □ Kindergarten □ 1st-2nd Grade □ 3rd-4th Grade □ 5th-6th Grade

Who:

Games: All Games will be played at Copperview Recreation Center Softball fields

I would like to coach: NAME:________________________________________ Phone # ___________________________

(T-Ball 3-5 year olds, Coach Pitch 6-7 year olds)

Best Email Address______________________________________________

Who: Boys and Girls Co-ed League

Spring Broucher  

Spring Programs

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