The Official Website of Dexter Parks and Recreation Department - Dexter, Missouri


2012 Swim Lesson Registration
 If you have any questions please contact the park office 573-624-8244. 

WAIVER 
 (PLEASE READ)
I, parent or guardian of the named participant, hereby waives all claims against the City of Dexter, the Parks Department, and any other personnel involved in any injury or accident while participating in this program. I also grant permission to managing personnel or other representatives to authorize and obtain medical care should the above participant become ill or injured when neither parent nor guardian is available to grant authorization for emergency treatment.
I also certify that all information on this form is true and that misrepresentation could result in suspension from this program.

We as parents (guardians) of the above named child give our permission to his/her participation in this year's program. We assume all risks and hazards incidental to such participation in this program. We understand we are responsible for our child's transportation to/from the program and borrowed equipment in our possession at the end of the program. 
We give Department of Parks and Recreation of any registration implies that all participants are specifically granting irrevocable permission to Parks and Recreation and its assigns, both during and anytime after, to use their likeness, name, voice, or words in either television, radio, film, newspaper, magazines, and other media and in any other form for the purpose of advertising or communicating  the purposes and activities of the Department of Parks and Recreation. 

BY SUBMITTING THIS ONLINE FORM YOU CERTIFY THAT YOU HAVE READ AND AGREE TO THIS WAIVER AND THAT YOU HAVE THE LEGAL AUTHORITY TO MAKE THIS DECISION.


Swimmer Information

  Name           
 Address              
  Phone          
  Gender            Birthday (MM/DD/YY)

PLEASE SELECT WHICH LESSON & LEVEL YOU ARE APPLYING 
  SWIM LESSONS:
 LEVEL:                   

 PRE-SCHOOL LESSONS:
 LEVEL:                                

 PARENT & CHILD LESSONS:
 LEVEL:                                       

 FOR PRIVATE LESSONS CONTACT PARK OFFICE  624-8244

Special Instructions
List Medical and Other Special Instructions



Parent / Guardian Information

Parent/Guardian 
Mailing Address           
Email    City, ZIP
Phone
Applicant is:           

Add other parent information:
Parent/Guardian 
Mailing Address           
Email    City, ZIP
Phone
Applicant is:    

I UNDERSTAND AND HAVE READ THE WAIVER LISTED
ON THIS FORM, AND AGREE

INITIALS OF PARENT/GUARDIAN


No Refunds

   
Copyright ©2011 Dexter Parks and Recreation Department.   All rights reserved.