SUMMER- Zumba Classes
Tuesday Nights - 6:15pm-7:15pm - May 30th - July 25th (No Class on July 4th)

WHERE: PV Town Park - Pavilion

COST: $15 Per Class / $50 - 4 Classes / $70 - 6 Classes / $90 - 8 Classes
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Liability Emergency Medical Release:
I hereby give my permission to participate in the town sponsored Putnam Valley Parks & Recreation program. I certify that I am physically fit and that I will not hold PVPR or its agencies and/or representatives liable for any accidents and/or injuries incurred during the course of the program. I give my personal consent to be transported to any emergency facility if injury is sustained. I also consent to any treatment, surgery, diagnostic procedure or the administration of anesthesia that may be deemed necessary based on the medical judgment of the attending physician. PVPR will not tolerate abusive language or any type of misconduct at any of its functions.
Program Refund Policy:
A credit or refund will be given for any program canceled by the Putnam Valley Parks & Recreation Department.  Once a participant has been enrolled in a particular program, refunds will not be considered, as these programs are dependent upon structure and pre-arrangement.  Therefore, anyone signing up pays a non-refundable fee.  Refunds would only be granted if the participant were to miss a prolonged period of time (more than half the program) due to injury/illness and is no longer able to participate for the remainder of the program.  When the participant becomes ill/injured, a doctor's note statement must be presented for verification.  All refunds given will be prorated from the date of notification to the Recreation Department.

Note: All fees are 100% refundable if requested ten days prior to program start dates.  Requested refund checks take at least two to four weeks to process.  The Town of Putnam Valley will charge a $20 service for returned checks.  Inquiries regarding refunds should be directed to: Putnam Valley Parks & Recreation Department.
Name of Participant: *
Emal: *
Phone #: *
Which Classes are you Signing up for?: *
I understand this informed Consent Form & Refund Policy & agree to its conditions.  Participant Name & Date: *
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