City of Elko Recreation/Class Program Registration Form
   
     
 
Walk-in Registration		   
After Hours Registration
Mail-in Registration

Elko Parks & Recreation Department Office
723 Railroad Street
Elko, NV  89801
MONDAY-FRIDAY
8:00 am - 2:00 pm
 

A 24-hour drop box is available at City Hall. Envelopes must include completed registration form and check/money order. Envelopes must clearly identify Parks & Recreation Registration. 
 

Mail the completed form below, with payment included, to:
***
Elko Parks & Recreation
1751 College Avenue
Elko, NV  89801
 

Parent/Adult
Name: 		Home
Phone: 		Work
Phone:
                Last                                    First
Address:
City

Zip

 

In Emergency, Contact:

                         Name

Relationship to Participant 

Phone

 
If participant has allergies/special medication, special needs or accommodations, please list:
Participants Name:
(List first & last 
name if different than parent's name above)		 Youth
Age		 Class/Program Name Date Time

Fee

For and in consideration of the voluntary participation in and use by above named participant of the recreational programs and facilities of Elko Parks and Recreation, at any time hereafter, the undersigned, his heirs, executors, administrators, and assigns hereby expressly release Elko Parks and Recreation, its offices, directors and agents from all claims and hereby expressly covenant and agree to refrain from bringing any action against Elko Parks & Recreation, or the City of Elko, for damage resulting from his or her participation in said recreation program, or use of said recreation facilities in conjunction herewith. I further state that I have read and understand the foregoing release and covenant no to sue. i know the contents thereof and sign the same as my own free act.

                    Total: $

Make Check payable to: 
Elko Parks & Recreation
CODE OF CONDUCT- Participant Guidelines
Equal Access- No participant shall on the basis of race, sex, creed, national origin or disability, be denied equal access to programs, activities, services or benefits, or be limited in the exercise of any right, privilege, advantage, or opportunity. 
Behavior- Participants are expected to exhibit appropriate behavior at all times. The following guidelines have been developed to make recreation department programs safe and enjoyable for all participants. Additional rules my be developed for particular programs and athletic leagues as deemed necessary by staff. Participants shall:
  • Show respect to all participants and staff
  • refrain from using foul language
  • refrain from causing bodily harm to other participants or staff
  • show respect for equipment supplies, and facilities
Discipline- A positive approach will be used. The Elko Parks and Recreation Department reserves the right to dismiss a participant. Each situation will be evaluated on its own merit. 
 
Family Physician: 		 
Phone Number:
 
Does your Child have any special needs we should now about?
 
 
List any medications:
Any medical problems (such as allergies, vision, hearing, diabetes):
 
My Child, has no known problems or allergies.
(Please initial)
 
In the event of an emergency, what should be taken?
Whatever is necessary! (please initial) Other (please initial)
If other, please explain:
 
Person to contact in case of emergency other than parent or guardian:
Name: Daytime #'s
Name:
 		 Daytime #'s
 
We the undersigned, as parent, parents, or legal guardian of above said child, a minor, do hereby authorize and consent to any x-ray examination, anesthetic, medical or surgical diagnosis. Treatment of hospital care rendered to the minor under general or special supervision of any member of the medical staff or emergency room staff duly licenses under the provisions of the medicine practice act, or a dentist duly licensed under the provision of the Dental Practice Act. 
 
The undersigned hereby agrees to bear all costs incurred as a result of the foregoing. This authorized will remain in effect until revoked by the undersigned.
Insurance Carrier's Name:
Signature: Date:
       
   
       
   
       

 

City of Elko, 1751 College Avenue, Elko, Nevada 89801
Phone: (775) 777-7110 Fax: (775) 777-7119
email:cityofelko@ci.elko.nv.us
Copyright 2001 City of Elko- All Rights Reserved
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