Community Recreation Registration - Lake County Board of DD / Deepwood

Please complete the form below to register for activities listed in the brochure located on the Community Recreation page. If you have any questions, please call 440-350-5165. See you soon!

Activity #1 *

Activity #2

Activity #3

Your Name *

Email Address *

Age *

Address *

Program Area *

Phone Numbers *
Day: Evening:

Parent/Guardian Information *
Parent/Guardian Name *

Parent/Guardian Email: Parent/Guardian Phone:

EMTA *
AttachedOn File

If you selected 'Attached' above, please upload your document here:

I understand that any fees associated with this event will be due on the day of the event.

I understand that photos may be taken at this event and used for county board marketing purposes. Registration for activities is consent for image use. NOTIFY RECREATION SPECIALIST IF YOU DO NOT WISH FOR YOUR PICTURE TO BE TAKEN.

Liability Waiver

In consideration of the opportunity afforded me to participate in Recreation/Special Olympics activities with the Lake County Board of Developmental Disabilities (LCBDD), in which I have and will participate freely and voluntarily, and in light of this opportunity afforded me, and the aims and services provided to individuals who have developmental disabilities by the LCBDD, I hereby waive any rights or causes of action against the LCBDD, its Board members, managers, employees, officers, directors, participants, collectively or individually, for any and all personal injury to me or members of my family, or damage to my property sustained in connection with my activities or travel for the LCBDD, or my participation in such activities. I fully understand that the activities in which I will engage might include, but are not limited to, physical activity and contact. I further understand the inherent risk of contracting COVID-19 through coaching or participating in sports, competition and/or any group activity offered by the LCBDD. I also understand that an individual with an intellectual disability and/or with high-risk conditions may be at a higher risk of experiencing an adverse outcome, up to and including severe disability or death, should they become infected with COVID-19. I understand this and am choosing to coach or participate in sports, competition, and/or other similar activities at my own risk. The undersigned further declares and represent that no promise, inducement or agreement not herein expressed has been made to the undersigned and that this Waiver contains the entire agreement between the parties hereto, and that the terms of this waiver are contractual and not mere recital.

The undersigned acknowledges READING AND FULLY UNDERSTANDING THE TERMS OF THIS WAIVER.

Participant Electronic Signature:

Required for any adult with capacity to sign legal documents. By signing this waiver, I acknowledge that I have completely read and fully understand the potential risk to my participation.
Please type your full name in the field above to sign.
Date (Month-Day-Year)

Parent/Guardian Electronic Signature:

I am a parent or guardian of the individual named above and have read and understand this waiver and have explained the contents to the individual as appropriate. By signing, I agree to this waiver on my own behalf and on behalf of the jparticipant.
Please type your full name in the field above to sign.
Date (Month Day, Year)

I have read and attest to the above