Access Leisure Calendar

Event Registration

• Access Leisure Registration Forms (Please fill out the appropriate form)
  If you are not familiar with this program, please read the below policies before attempting to register.
  

Access Leisure Event Registration Policies

1. NO faxed or phoned-in registrations, or registrations mailed in without fees.
2. Please completely fill out registration forms and print CLEARLY.
3. Registrations must be received five days prior to the event date.
4. Be aware that mailing in registrations does not guarantee acceptance into the program.
5. Individuals whose checks bounce will be responsible for the amount of the check plus associated bank fees.
6. If you are a rider of ParaTransit and you have a pick-up time later than thirty
minutes after the scheduled end of the program, we ask you to find an alternative means home.
7. We are unable to administer medication during program hours. Participants must be able to take own meds or have an attendant provided to assist them.
8. Events costing $10 or more, personal assistants will need to cover the program fees.
9. Refund Policy: Full Refund 72 hours prior to the event; 50% within 72 hours; No refunds day of and after event.

Make checks payable to:
City of Sacramento.

Mail forms to:
ATTN: Phil, Access Leisure
3291 Truxel Road, #26K, Sacramento, CA 95833

For more information or if you have questions call (916) 808-6045.

Forms

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[    ] Evening Social, Thursday, Feb 25  Cost $8.00 ($9.00 at the door)

NAME _____________________________________ M[ ] F[ ] AGE _______

ADDRESS______________________CITY _____________ ZIP__________

PHONE#________________________ EMERGENCY#______________________

SPECIAL INFO_____________________________________________
Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.

SIGNATURE____________________________________ DATE___________

Office Use Only: Amt Pd:$ __________ Amt Due:___________
Ck or MO#:_________Cash  __  CC__ Rcpt #:_______Date: ___________

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[    ]Lunch & Cinema – Saturday, Feb 27, 10:45am – 3:00pm 
$8.00 Registration Fee (Please pay in advance, must be mailed)

NAME _____________________________________ M[ ] F[ ] AGE _______

ADDRESS______________________CITY _____________ ZIP__________

PHONE#________________________ EMERGENCY#______________________

SPECIAL INFO_____________________________________________
Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.

SIGNATURE____________________________________ DATE___________

Office Use Only: Amt Pd:$ __________ Amt Due:___________
Ck or MO#:_________Cash  __  CC__ Rcpt #:_______Date: ___________

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[    ] Lunch & Cinema, Sat, March 6, Cost $8.00 (This Fee Must Be Mailed)

NAME _____________________________________ M[ ] F[ ] AGE _______

ADDRESS______________________CITY _____________ ZIP__________

PHONE#________________________ EMERGENCY#______________________

SPECIAL INFO_____________________________________________
Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.

SIGNATURE____________________________________ DATE___________

Office Use Only: Amt Pd:$ __________ Amt Due:___________
Ck or MO#:_________Cash  __  CC__ Rcpt #:_______Date: ___________

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[    ] Video Pizza, Mon, March 8, Cost $8.00 ($9.00 @ Door)

NAME _____________________________________ M[ ] F[ ] AGE _______

ADDRESS______________________CITY _____________ ZIP__________

PHONE#________________________ EMERGENCY#______________________

SPECIAL INFO_____________________________________________
Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.

SIGNATURE____________________________________ DATE___________

Office Use Only: Amt Pd:$ __________ Amt Due:___________
Ck or MO#:_________Cash  __  CC__ Rcpt #:_______Date: ___________

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[    ] Evening Social, Thursday, March 25, Cost $ 8.00 ($9.00 @ The Door)

NAME _____________________________________ M[ ] F[ ] AGE _______

ADDRESS______________________CITY _____________ ZIP__________

PHONE#________________________ EMERGENCY#______________________

SPECIAL INFO_____________________________________________
Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.

SIGNATURE____________________________________ DATE___________

Office Use Only: Amt Pd:$ __________ Amt Due:___________
Ck or MO#:_________Cash  __  CC__ Rcpt #:_______Date: ___________

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NAME _____________________________________ M[ ] F[ ] AGE _______

ADDRESS______________________CITY _____________ ZIP__________

PHONE#________________________ EMERGENCY#______________________

SPECIAL INFO_____________________________________________
Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.

SIGNATURE____________________________________ DATE___________

Office Use Only: Amt Pd:$ __________ Amt Due:___________
Ck or MO#:_________Cash  __  CC__ Rcpt #:_______Date: ___________

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[    ]Special Events:
Crafts Day, Saturday, Feb 20, 2:00-4:00pm, $12.00.

NAME _____________________________________ M[ ] F[ ] AGE _______

ADDRESS______________________CITY _____________ ZIP__________

PHONE#________________________ EMERGENCY#______________________

SPECIAL INFO_____________________________________________
Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.

SIGNATURE____________________________________ DATE___________

Office Use Only: Amt Pd:$ __________ Amt Due:___________
Ck or MO#:_________Cash  __  CC__ Rcpt #:_______Date: ___________

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[    ]Special Events:
Bok Kai Parade, Sat, March 20, Cost $35.00

NAME _____________________________________ M[ ] F[ ] AGE _______

ADDRESS______________________CITY _____________ ZIP__________

PHONE#________________________ EMERGENCY#______________________

SPECIAL INFO_____________________________________________
Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.

SIGNATURE____________________________________ DATE___________

Office Use Only: Amt Pd:$ __________ Amt Due:___________
Ck or MO#:_________Cash  __  CC__ Rcpt #:_______Date: ___________

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[    ]Special Events:
Red Hawk Casino, Wed, March 31, Cost $45.00 (During Spring Break)

NAME _____________________________________ M[ ] F[ ] AGE _______

ADDRESS______________________CITY _____________ ZIP__________

PHONE#________________________ EMERGENCY#______________________

SPECIAL INFO_____________________________________________
Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.

SIGNATURE____________________________________ DATE___________

Office Use Only: Amt Pd:$ __________ Amt Due:___________
Ck or MO#:_________Cash  __  CC__ Rcpt #:_______Date: ___________

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[    ]Special Events:
CSUS Women Vs Texas Gymnastics, Friday, March 12,  $8.00 (This Fee Must Be Mailed)

NAME _____________________________________ M[ ] F[ ] AGE _______

ADDRESS______________________CITY _____________ ZIP__________

PHONE#________________________ EMERGENCY#______________________

SPECIAL INFO_____________________________________________
Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.

SIGNATURE____________________________________ DATE___________

Office Use Only: Amt Pd:$ __________ Amt Due:___________
Ck or MO#:_________Cash  __  CC__ Rcpt #:_______Date: ___________

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BOWLING LEAGUES

[    ] PIN PALS, Alpine Bowling Center, $5.00
[    ]ROCK 'N BOWLING, Alpine Bowling Center, $4.00
[    ]BLUEBIRDS, Alpine Bowling Center, $3.00
[    ]BLUEBIRDS, Alpine Bowling Center, $3.00

NAME _____________________________________ M[ ] F[ ] AGE _______

ADDRESS______________________CITY _____________ ZIP__________

PHONE#________________________ EMERGENCY#______________________

SPECIAL INFO_____________________________________________
Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.

SIGNATURE____________________________________ DATE___________

Office Use Only: Amt Pd:$ __________ Amt Due:___________
Ck or MO#:_________Cash  __  CC__ Rcpt #:_______Date: ___________

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