Professional Documents
Culture Documents
Household Information Form
Household Information Form
Name_________________________________
Name_________________________________
Address: ______________________________
Address: ______________________________
Phone:
Phone:
Home: ___________________
Home: ___________________
Work: ___________________
Work: ___________________
Cell: ____________________
Cell: ____________________
Waiver Agreement
Release of Liability: I authorize the staff and volunteers of the Randolph Recreation Department to provide basic first aid or to call
additional medical care in the event of an emergency, for the above listed individual. I understand the inherent risk in participating in this
program and hereby give my consent, for above listed participant, to participate in programs offered by the Town of Randolph Recreation
Department. I further agree to release the Town of Randolph and their staff and volunteers from any liability connected with the above listed
individual.
Consent: I hereby consent to and authorize the Town of Randolph Recreation Department the rights to publish, reproduce and use for
advertising or any other purpose any photograph, video image, audio recording and other likeness of individuals listed on this registration.
YES
NO
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