Village of Lewiston Recreation Indoor Soccer
Village of Lewiston Recreation Address: 145 N. 4th Street, Lewiston, NY 14092
Program will be held at: WTS, 435 N. 2nd Street, Lewiston, NY 14092
Contact us at (716) 754-1990 or
RELEASE OF LIABILITY
In consideration of permitting the below-named child to participate in games, practices, and other activities of the Village of Lewiston Recreation Department, I, the undersigned as parent or guardian of said minor, do hereby release and agree to hold harmless the Village of Lewiston Recreation Department and its said agents, employees, coaches and volunteers from any liability for bodily injury, personal injury or property damage which may occur to said minor on the part of said program or its agents, employees, coaches and volunteers related to this program.
Child's Last Name
Child's First Name
Child's Date of Birth
Parent's Full Name
Parent Phone Number
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