Payette Lakes Community Association
Summer Program Registration Form 2014
(One Child per form)
Participants Name:_____________________________ Age _____ Date of Birth _______ Sex M / F
Email:________________
Physical Address:_______________________ Mailing Address:_____________ City:____________ State: ______ Zip:_______
In case we can not contact parent/guardian call____________________________________ Phone #_______________________
I, the parent of the above named participant/or participants do assume all risks and hazards incidental, including death or permanent disability, to the conduct of the
activity. I do further hereby release, absolve, indemnify, and hold harmless the Payette Lakes Community Association, it’s officers, employees, representatives, agents,
assigns, and volunteers, from any an all injuries, death, illness, disease, damages or losses of whatever kind, nature, or amount suffered by me or by such minor
participant at any activity sponsored, in whole or in part, by the Payette Lakes Community Association to which this participant’s registration form relates. I
understand that the Payette Lakes Community Association provides no accident or medical insurance and that this is personal responsibility. I hereby give consent for
emergency medical treatment. I understand that this is to prevent undue delay and assure prompt treatment and that only a licensed physician will be engaged for
such an emergency.
Date: ________ Parents or Guardian’s Signature:_____________________________ Please Print Name:___________________________
Phone Numbers
Day:______________________ Evening:___________________ Cell _________________________
Make all checks payable to:
Attend
Payette Lakes Community Association
EVENTS
Fun Day in the Park
Lacrosse Clinic
Kayak, Sand Castles & BBQ
Bike Trip - Novice and Skilled
or join in a hike
Fun Day at Paradise Point
Paradise Point Overnight
DATE
July 4 &5
Fri. July 11 &
Sat. July 12th
Thurs. July 17
and mail to
PLCA, PO Box 1118, McCall, ID. 83638
Time
11:00 am – 6:00 pm
Location
Depot Park (fee per day paid at park)
Fee
$5
9:30 am – 1:00 pm
Fairway Park Athletic Field
Fee - $10
Bring Lunch Age 10 - 14
Bus from Senior Center at 9:00 am, return
1:30, lunch provided, Fee - $5 Age 8-12
$10
9:00 am – 1:30 pm
$5
Fri. July 25
9:30 am – 12:00 pm
Bear Basin Trailhead. Registration at 9:00 and
ride starts at 9:30. Bike & helmet required.
-0-
Mon. Aug 4
8:30 am – 3:30 pm
Busing from McCall Senior Center at 9 am
to Paradise Point. Fee $10 Age 7-12
Drive to Paradise Point for overnight trip.
Ages 8 to 12 Must register before Aug 1st
Total
$10
Aug 18 &
Aug 19th
9 am on 12th to 4:00
pm on 13th
$45
Medical (Allergies, etc.)
If you need more information or would like to be a volunteer for any of the activities, please contact
Erin Greaves – 315-5411
2/7/16