(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.
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_______________
Parent or Guardian____________________________ Best Email Address________________________________
Name of Participant___________________________Birth date_________Age________ Girl _____Boy____
Copperview Recreation Center
Program includes: Hat, shirt, 8 games, participation award, and 2 bees ticket vouchers
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
$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:
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)
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
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