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Summer Outreach Program Registration

  1. Police Outreach Program Registration Form

  2. Does you child have any allergies and/or intolerances to food, medication or any other substances?*

  3. INDEMNIFICATION

  4. I hereby represent and warrant to the City of Prospect that I have the authority to execute this Participant Waiver Form on behalf of myself and/or on behalf of my minor child(ren) or ward(s) as parent, guardian and/or next friend, if applicable. In the event of any misrepresentation or breach of the foregoing warranty by me, or in the event that I, my minor chlld(ren) or ward(s), or any other person nevertheless asserts any claim against the City of Prospect Heights arising out of my or my minor chlld(ren)'s or ward(s)' participation in any program, event, class or other activity as set forth herein, I agree to indemnify, hold harmless and defend the City of Prospect Heights from and against any and all liability, claims, losses, costs, expenses or damages resulting therefrom, including, but not limited to, claims of loss, damage, illness or injury to person or property whether or not such loss, damage, illness or injury results from the negligence of the City of Prospect Heights or from some other cause. I expressly acknowledge and agree to the terms and conditions set forth on this Police Outreach Program Registration Form.*

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  6. This field is not part of the form submission.