Page 50 - Yorba Linda Fall 2025

Information // Program Registration Information
City of Yorba Linda • Parks and Recreation
MAIL-IN REGISTRATION FORM
(Checks Only Payable to the City of Yorba Linda)
Mail completed Registration Form and check to:
City of Yorba Linda, Program Registration, 4845 Casa Loma Ave., Yorba Linda, CA 92886-8714
INFORMATION
2026 July 4th Spectacular Donation
(Donations will help provide kids activities at the July 4th Fireworks Show)
TOTAL PAID
50
LIABILITY WAIVER
RELEASE OF LIABILITY AND INDEMNIFICATION - In consideration for the City’s acceptance of this registration in City Program(s), I agree to release, indemnify, defend, and
hold harmless City and its officers, agents, employees, or volunteers (“City Personnel”) from and against any and all losses, damages, expenses, liabilities, actions, or
claims of any nature, whether known or unknown, either in law or equity, which may arise from participation in a Program, for any reason including but not limited to
the active or passive negligence of the City, City Personnel, or any other individual or entity. I further understand and agree to assume the risks, if any, arising from my
participation in the Program and the conditions and use of equipment and facilities owned by the City.
PHOTO RELEASE - The City may take, use, and publish photos, videos, and/or audio recordings of Participant for publicity purposes. I hereby grant the City permission to
use his/her likeness, name, voice and words, in any broadcast, telecast, or print media account free of charge.
MEDICAL RELEASE FOR MINORS - In the event my child is injured or ill, I hereby authorize City Personnel to consent to medical treatment for my child. I understand and
acknowledge that I will be responsible for payment of all medical services rendered, including reimbursement to the City for any medical expenses incurred in the care
of my child.
(IF THE PARTICIPANT IS A MINOR) I, _____________________, hereby warrant that I am the custodial parent/legal guardian of ________________________,
who is a minor. I CERTIFY THAT I HAVE READ, UNDERSTAND AND VOLUNTARILY SIGN THIS WAIVER AND RELEASE ON BEHALF OF MY HEIRS, SUCCESSORS, AND ASSIGNS
AS IT APPLIES TO MYSELF AND TO ANY MINORS FOR WHOM I AM SIGNING.
I, __________________________, CERTIFY THAT I HAVE READ AND UNDERSTAND THIS WAVIER AND RELEASE AND SIGN IT VOLUNTARILY.
X ____________________________________________________ Date:____________________
Adult Participant/Parent/Guardian Signature for Minor Participant Signature
PRIVACY STATEMENT: The City of Yorba Linda takes your privacy seriously. Instructors will receive only the name, current age, address and phone number of participants.
E-mail addresses will only be utilized for Department correspondence related to your registration, promotions, and to inform you of upcoming events. Unless required by
court order, your information will not be shared with other agencies, departments, businesses, or individuals. If you feel that your rights and privacy have been violated,
please contact the Recreation Department at 714-961-7160.
All persons are prohibited from participating in a City of Yorba Linda (“City”) Parks and Recreation Program (“Program”) prior to executing and submitting this waiver
(“Waiver”) to the City. This Waiver applies to all Programs and shall remain in effect for one (1) year from the date it is executed.
NAME OF PARTICIPANT:______________________________________
THE GUIDE // Fall 2025 // Yorba Linda Parks and Recreation