Author: Melyssa Woodford

Orangevale Recreation & Park District

REGISTRATION FORM

(Please Print)

REGISTRATION DIRECTIONS: Use the section below to register all members of the same family for the TigerSharks Swim Team.

Swimmer Name	Sex	Birthdate	Age	Age Group*	Season Code	Fee (NR Fee)
1.					2025 Summer	$197 ($202 NR)
2.					2025 Summer	$192 ($197NR)
3.					2025 Summer	$187($192 NR)
4.				15-18 yr w/volunteer coaching	2025 Summer	$107 ($112 NR)

				Total Fees Due
				Fees Paid
				Balance Due

* Age Group is determined by child’s age as of June 1, 2025.

All balances are due and payable on or before April 7, 2025

PAYMENTS: 1st ______ Ch / Ck / CC 2nd ______ Ch / Ck / CC

FAMILY INFORMATION

Family Name (Last name for family folder)
Parent/Guardian Name (First &Last, MI)
Address City Zip
Phone 1 Phone 2
E-mail

r home
r work
r cell

r home
r work
r cell

ORANGEVALE RECREATION & PARK DISTRICT AGREEMENT, WAIVER, AND RELEASE
In consideration for being permitted by the District to participate in the above-referenced activity, I hereby waive, release, and discharge any and all claims for damages for personal injury, death, or property damage which I may have, or which may hereafter accrue to me, as a result of participation in said activity. This release is intended to discharge in advance the District (including its officers, employees, volunteers, and agents) from any and all liability arising out of or connected in any way with my participation in said activity, even though that liability may arise out of active or passive negligence or carelessness on the part of the persons or entities mentioned above. It is further agreed that this waiver, release and assumption of risk is to be binding on my heirs, administrators, executors, and assigns and that I shall indemnify and hold the District (including its officers, employees, volunteers, and agents) free and harmless from any loss, liability, damage, cost, or expense which may arise out of or connected in any way with my participation in said activity. Additionally, I fully understand that my participation in the above-referenced activity exposes me to the risk of personal injury, death, communicable diseases, illnesses, viruses, and/or property damage. I hereby acknowledge that I am voluntarily participating in this activity and agree to assume any such risks.
PHOTO/VIDEO RELEASE: I understand that photographs/videos may be taken during this activity and hereby grant the District permission to use any such photo(s)/video(s) for advertising or in promotional materials.
PARENTAL CONSENT: (to be completed & and signed by parent/guardian if Participant is under 18 years of age) I hereby consent that my son(s)/daughter(s), ____________________________, participate in the above-referenced activity, and I hereby execute the above Agreement, Waiver, and Release on his/her behalf. I state that said minor is physically able to participate in said activity. I hereby agree to indemnify and hold the District (including its officers, employees, volunteers, and agents) free and harmless from any loss, liability, damage, cost, or expense which may arise out of or connected in any way with said minor’s participation in said activity.
I HAVE CAREFULLY READ THIS AGREEMENT, WAIVER, AND RELEASE AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND THE ABOVE DISTRICT AND I SIGN IT OF MY FREE WILL.
Signature Date
Name Printed Circle—Parent/Guardian

OFFICE USE ONLY
Rec#
Date/Initial

Orangevale Recreation & Park District
6826 Hazel Avenue s Orangevale, CA 95662 s 916-988-4373
TigerSharks Swim Team
Personal Information & Photo/Video Release
PERSONAL INFORMATION RELEASE
In consideration of participating in the TigerSharks Swim Team program, parents and/or other program participants may have the occasion or need of contacting one another for possible work assignments & substitutions, car pooling, notifications of sick children and the like. The Orangevale Recreation & Park District asks for your advance authorization to release your phone number and/or address to the TigerSharks Parent Board and Chairpersons and parents/guardians of program participants only.
I have read and understood the above explanation of how the District intends to release personal information and agree to all the District to release my personal information.
Signature Date
Printed Name
PHOTO/VIDEO RELEASE
As a means of promoting the TigerSharks Swim Team, there may be occasions that would make effective promotional photographs/videos during the course of your child’s participation in the program. The Orangevale Recreation & Park District staff/volunteers may take and or publish photographs/videos of your child during his/her normal participation in the TigerSharks program. These photographs/videos may be used in the District’s Activity Guide, promotional flyers, newspaper articles, promotional displays, District website & TigerSharks website, and District Facebook/Instagram pages. Photographs/videos of participating children shall not be released to any public entity and/or individual for any other non-specified purpose under any circumstances.
I hereby give my consent to have the Orangevale Recreation & Park District staff/volunteer periodically take photographs/videos of my child for promotional purposes. I have read and understood the above explanation of how the District intends to utilize such photographs/videos and agree to these purposes.
Signature Date
Printed Name