CREDIT CARD INFO (No Amex): Number” __________________________________________
Beginning September 2017 all programs will be subject to a 2% processing fee for all credit card payments.
Expiration date: ______________ Security Code: ________________
E-MAIL ADDRESS: _____________________________________________________________
______________________ has my permission to participate in the Southeast Recreation program. I assume all risks and hazards incidental to such participation including transportation to and from activities. I do hereby waive, release, absolve, in- demnify and agree to hold harmless the sponsors and coaches for any claim arising out of an injury to my child. I also understand that it is my responsibility to notify the instructor of any MEDICAL/PHYSICAL condition that could limit my child’s participation