2008 Access Leisure
Registration Forms
and Program Registration Policies
IMPORTANT: Please complete the correct form below.
Make checks payable to City of Sacramento.
Mail forms to Attention:
Phil, Access Leisure, 6005 Folsom Blvd., Sacramento, CA 95819
For more information or if you have questions call (916) 808-6045.
ACCESS LEISURE 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. A surcharge will be added to registration if you prefer paying at the door at events.
Please do not staple or tape checks to forms.
If you have questions call 808-6045.
| WOULD YOU LIKE TO RECEIVE OUR MONTHLY CALENDAR VIA
E-MAIL??? |
In an attempt to cut costs and make receiving monthly event updates
more convenient, Access Leisure will be offering our monthly calendar
via e-mail using the Acrobat Reader PDF format (the Acrobat Reader program
is available for free). If you receive the calendar by e-mail you will
no longer receive the paper calendar via US Mail. If interested, please
e-mail psinclai@cityofsacramento.org with your name and e-mail address. |
YOU MUST PRE-REGISTER FOR PROGRAMS. |
PLEASE PRINT CLEARLY
AND FILL OUT FORM(S) COMPLETELY. |
CREDIT CARD OPTION
If you would like to use your credit card (minimum charge of $25.00), fill out the info below and send info with registrations to:
City of Sacramento, 6005 Folsom Blvd, Sacramento, CA. 95819, Attn: Access Leisure
Please Charge my Credit Card for the amount of $ __________
Visa or Master Card ONLY Credit Card # ________________________________
Card Exp Date: ___/___ mm/yy
3 Digit Verification Code (Back of Card) _______
Signature ____________________________________________
Date: __________________________
|
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WALKING FOR FITNESS, THU, JUNE 5[ ]; 12[ ]; 19[ ]; 26[ ]; FREE
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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POPS IN THE PARK CONCERTS, SAT, JUNE 7 [ ]; JUNE 28 [ ] - COST $6.00 PER DATE
NAME _____________________________________ M[ ] F[ ] AGE _______
ADDRESS__________________________CITY ____________________
ZIP__________PHONE#________________________
EMERGENCY#______________________
SPECIAL INFO_____________________________________________
Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.
SIGNATURE____________________________________ DATE___________
Office Use Only:Amt Pd:$ __________ Amt Due:___________
Ck or MO#:_______________ Cash __ CC__
Rcpt #:_____________ Date: __________
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VIDEO/PIZZA NIGHT, MON, JUNE 9 - COST IS $7.00 ($8.00 AT THE DOOR)
NAME _____________________________________ M[ ] F[ ] AGE _______
ADDRESS__________________________CITY ____________________
ZIP__________PHONE#________________________
EMERGENCY#______________________
SPECIAL INFO_____________________________________________
Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.
SIGNATURE____________________________________ DATE___________
Office Use Only:Amt Pd:$ __________ Amt Due:___________
Ck or MO#:_______________ Cash __ CC__
Rcpt #:_____________ Date: __________
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LUNCH & CINEMA, DOWNTOWN PLAZA, SAT, JUNE 14 - COST $6.00
NAME _____________________________________ M[ ] F[ ] AGE _______
ADDRESS__________________________CITY ____________________
ZIP__________PHONE#________________________
EMERGENCY#______________________
SPECIAL INFO_____________________________________________
Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.
SIGNATURE____________________________________ DATE___________
Office Use Only:Amt Pd:$ __________ Amt Due:___________
Ck or MO#:_______________ Cash __ CC__
Rcpt #:_____________ Date: __________
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SAC ZOO CONCERTS, TUE, JUNE 17 [ ]; JUNE 28 - COST $8.00 PER DATE
NAME _____________________________________ M[ ] F[ ] AGE _______
ADDRESS__________________________CITY ____________________
ZIP__________PHONE#________________________
EMERGENCY#______________________
SPECIAL INFO_____________________________________________
Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.
SIGNATURE____________________________________ DATE___________
Office Use Only:Amt Pd:$ __________ Amt Due:___________
Ck or MO#:_______________ Cash __ CC__
Rcpt #:_____________ Date: __________
----------------------------------------------------------------------
PAPER BOWLING TOURNAMENT LEAGUE, WEDS, JUNE 18 – AUG 6, $5.00 PER WEEK
NAME _____________________________________ M[ ] F[ ] AGE _______
ADDRESS__________________________CITY ____________________
ZIP__________PHONE#________________________
EMERGENCY#______________________
SPECIAL INFO_____________________________________________
Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.
SIGNATURE____________________________________ DATE___________
Office Use Only:Amt Pd:$ __________ Amt Due:___________
Ck or MO#:_______________ Cash __ CC__
Rcpt #:_____________ Date: __________
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RIVER CATS VS GRIZZLIES, THU, JUNE 19 - COST $30.00
NAME _____________________________________ M[ ] F[ ] AGE _______
ADDRESS__________________________CITY ____________________
ZIP__________PHONE#________________________
EMERGENCY#______________________
SPECIAL INFO_____________________________________________
Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.
SIGNATURE____________________________________ DATE___________
Office Use Only:Amt Pd:$ __________ Amt Due:___________
Ck or MO#:_______________ Cash __ CC__
Rcpt #:_____________ Date: __________
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PASTA DINNER & DANCE, SAT, JUNE 21 - COST IS $16.00 (A RE-SCHEDULED EVENT FROM MAY)
NAME _____________________________________ M[ ] F[ ] AGE _______
ADDRESS__________________________CITY ____________________
ZIP__________PHONE#________________________
EMERGENCY#______________________
SPECIAL INFO_____________________________________________
Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.
SIGNATURE____________________________________ DATE___________
Office Use Only:Amt Pd:$ __________ Amt Due:___________
Ck or MO#:_______________ Cash __ CC__
Rcpt #:_____________ Date: __________
MUST PRE-REGISTER FOR PROGRAMS. PLEASE PRINT CLEARLY AND FILL OUT FORM(S) COMPLETELY.
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WALKING FOR FITNESS, WED, JULY 2 [ ]; 9 [ ]; 16 [ ]; 23 [ ]; 30 [ ]; FREE
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: __________
----------------------------------------------------------------------
PAPER BOWLING TOURNAMENT LEAGUE, WEDS, JULY 2 – AUG 6, $5.00 PER WEEK
NAME _____________________________________ M[ ] F[ ] AGE _______
ADDRESS__________________________CITY ____________________
ZIP__________PHONE#________________________
EMERGENCY#______________________
SPECIAL INFO_____________________________________________
Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.
SIGNATURE____________________________________ DATE___________
Office Use Only:Amt Pd:$ __________ Amt Due:___________
Ck or MO#:_______________ Cash __ CC__
Rcpt #:_____________ Date: __________
----------------------------------------------------------------------
LUNCH & CINEMA, REGAL NATOMAS THEATERS, TRUXEL, SAT, JULY 12 - COST $6.00
NAME _____________________________________ M[ ] F[ ] AGE _______
ADDRESS__________________________CITY ____________________
ZIP__________PHONE#________________________
EMERGENCY#______________________
SPECIAL INFO_____________________________________________
Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.
SIGNATURE____________________________________ DATE___________
Office Use Only:Amt Pd:$ __________ Amt Due:___________
Ck or MO#:_______________ Cash __ CC__
Rcpt #:_____________ Date: __________
----------------------------------------------------------------------
VIDEO/PIZZA NIGHT, MON, JULY 28 - COST IS $7.00 ($8.00 AT THE DOOR)
NAME _____________________________________ M[ ] F[ ] AGE _______
ADDRESS__________________________CITY ____________________
ZIP__________PHONE#________________________
EMERGENCY#______________________
SPECIAL INFO_____________________________________________
Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.
SIGNATURE____________________________________ DATE___________
Office Use Only:Amt Pd:$ __________ Amt Due:___________
Ck or MO#:_______________ Cash __ CC__
Rcpt #:_____________ Date: __________
----------------------------------------------------------------------
OL’ SAC LUNCH & A RIVERBOAT CRUISE, SAT, JULY 26, $30.00
NAME _____________________________________ M[ ] F[ ] AGE _______
ADDRESS__________________________CITY ____________________
ZIP__________PHONE#________________________
EMERGENCY#______________________
SPECIAL INFO_____________________________________________
Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.
SIGNATURE____________________________________ DATE___________
Office Use Only:Amt Pd:$ __________ Amt Due:___________
Ck or MO#:_______________ Cash __ CC__
Rcpt #:_____________ Date: __________
----------------------------------------------------------------------
SAC ZOO CONCERTS, TUE, JULY 8 [ ]; JULY 15 [ ]; JULY 22 [ ] - COST $8.00 PER DATE
NAME _____________________________________ M[ ] F[ ] AGE _______
ADDRESS__________________________CITY ____________________
ZIP__________PHONE#________________________
EMERGENCY#______________________
SPECIAL INFO_____________________________________________
Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.
SIGNATURE____________________________________ DATE___________
Office Use Only:Amt Pd:$ __________ Amt Due:___________
Ck or MO#:_______________ Cash __ CC__
Rcpt #:_____________ Date: __________
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RIVER CATS VS SOUND, THU, JULY 31 - COST $30.00
NAME _____________________________________ M[ ] F[ ] AGE _______
ADDRESS__________________________CITY ____________________
ZIP__________PHONE#________________________
EMERGENCY#______________________
SPECIAL INFO_____________________________________________
Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.
SIGNATURE____________________________________ DATE___________
Office Use Only:Amt Pd:$ __________ Amt Due:___________
Ck or MO#:_______________ Cash __ CC__
Rcpt #:_____________ Date: __________
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Water Aerobics, Thu, July 10 [ ]; July 17 [ ]; July 24 [ ]; July 31 [ ]; Bring $$ to event. $4.00 per program or $20.00 for 8 Sessions (this program will continue through the month of August).
NAME _____________________________________ M[ ] F[ ] AGE _______
ADDRESS__________________________CITY ____________________
ZIP__________PHONE#________________________
EMERGENCY#______________________
SPECIAL INFO_____________________________________________
Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.
SIGNATURE____________________________________ DATE___________
Office Use Only:Amt Pd:$ __________ Amt Due:___________
Ck or MO#:_______________ Cash __ CC__
Rcpt #:_____________ Date: __________
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