PALMER TOWNSHIP COMMUNITY CENTER
PROGRAM REGISTRATION FORM

I hereby release Palmer Township and any officers, directors, employees or agents from all claims for bodily injury, death or property damages arising out of my or my child's participation in the above program. I assume full responsibility for all liability in connection with such claims, and for having insurance for me and/or my child. I agree to indemnify Palmer Township and hold Palmer Township harmless against any such claims and related costs, including claims by any minor which may be brought after attain majority.

Signature of Participant ________________________________________ Date _________________

(or Parent/Legal Guardian if participant is under 18 years of age)

Monitors Signature ____________________________________________ Date _________________