Program Registration Atv Park 1 Day Pass

Please Fill In The Registration Info Below: * Required Fields
* First Name:
* Last Name:
* Sex:
* Address:
* City:
* State:
* Zip:
* Phone:
* Birth Date: Month Day Year

* Email Address:
* Emergency Contact:
* Emergency Relationship:
* Day Phone:
* Evening Phone:

Registration Fee: $ 10.00
* Your Name:  (as it appears on card)
* Credit Card Number:
(Visa, Mastercard)
 CVC: what's this?
* Expiration Date:  (mm/yy)
Send Confirmation Email

Additional Comments (if any)


Every participant or parent/guardian of participants (under 18) must read and sign this waiver form. Signatures on this form signify that you have read, understand, and abide by the information herein. I understand that participation in any activates offered by the Brillion Community Center/City of Brillion are VOLUNTARY and that there are risks associated with participating in these event and its related activities. I hereby authorize and give my full consent to the City of Brillion/Brillion Community Center to copyright and/or publish any and all photographs, videotapes and/or film in which my family (children and/or spouse) or I may appear while attending city-sponsored events. I further agree that city may transfer, use or cause to use, these photographs, videotapes, or films for any exhibitions, public displays, publications, commercials, internet websites, art and advertising purposes, and television programs without limitations or reservations. I and my family also release, waive, discharge and covenant not to sue the Brillion Community Center, the City of Brillion, its employees, representatives, referees, land owners, or agents, and, I hereby agree to indemnify, defend and hold the Brillion Community Center and the City of Brillion harmless, for and from any and all actual or threatened causes of action, claims, damages, losses and/or costs, including reasonable attorney fees, of any kind or nature, including, but not limited to, lost profits, direct, indirect, incidental, consequential, special or punitive damages arising out of or relating to my, my child's, my spouse's or my family's participation in any activity or event offered by the City of Brillion/Brillion Community Center. When registering for a program you will be charged a fee based on your residency of the CITY of Brillion (not the township or school district of Brillion). If you live in the CITY of Brillion you pay the resident rate. If found that you are a non-resident and you registered as a resident for the discounted fee, your name will be removed from the program. Non-resident registration also begins at a later date than resident registration. Non-residents found signing up before their start time will have their names put on waiting lists. Participants registering online and have medical conditions, please note that in the "Additional Comments" section of the registration form. If you have questions about programs or on your resident status, please call the Brillion Community Center. I agree that this waiver form will stand as a valid agreement for all activities that I or my family participates in for the next 12 months from today's date. I have read and understand the terms of this waiver form and I voluntarily sign it.

    I have READ and AGREE to the above waiver: YES NO

Be sure to click SUBMIT ONCE when finished.
Due to possible high internet traffic, please give this process time to complete. If your browser times out and you are forced to re-click on submit and you get a Participant Already Registered message, you are registered.