FALL - Zumba Classes
WHEN: Tuesday Nights - 6:15pm-7:15pm
October 4th, 11th, 18th, 25th, November 1st, 8th
WHERE: PV Town Park - Pavilion
COST: $15 for 1 Class, $50 for 4 Classes, $70 for All 6 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.
Name of Participant:
Which Classes are you signing up for?
Tuesday, October 4th
Tuesday, October 11th
Tuesday, October 18th
Tuesday, October 25th
Tuesday, November 1st
Tuesday, November 8th
I understand this informed Consent Form & agree to its conditions. Participant Name & Date:
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