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2. Recovery Connections
   Sterling Heights Parks & Recreation, with the support of the Sterling Heights Drug Free Coalition, are here to support your recovery journey. Join one of our many fitness classes and make new healthy connections with yourself and others. The Recovery Connections program allows people struggling with addition or in recovery to receive a 50% discount on exercise classes.
4. First Name
5. Last Name
7. Email
8. Phone Number
10. Address1
12. Address2
14. City
15. State
16. Zip
18. Date of Birth
20. Gender
    -- Select One --MaleFemale
21. Gender Pronouns
23. Exercise Program Name
25. Program Day & Time
27. Activity Number
29. Emergency Contact
31. First Name
32. Last Name
34. Relation
35. Phone Number
37. Department of Parks and Recreation Release, Waiver, Hold Harmless, Indemnity and Participation Agreement
    The risks of injury and illness (ex: communicable diseases such as MRSA, influenza, and COVID-19) to my child from the use of the Sterling Heights Community Center and its amenities are significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce these risks, the risks of serious injury and illness do exist; and, in consideration of the City of Sterling Heights, City of Sterling Heights Department of Parks and Recreation (“City”) allowing me and/or my child or ward access to and use of the Community Center and its amenities, I for myself, spouse, and child or ward agree to: (A) Assume all risks of injury and property damage and accept all responsibility in case of accidents, injury or death; (B) RELEASE AND HOLD HARMLESS AND AGREE NOT TO SUE the City, its employees, and elected or appointed officials, for any claim, damages, costs or cause or action which I may have or suffer or may in the future have or suffer as a result of any accident, injury including death or damages sustained or incurred while accessing or using the Community Center and its amenities, even if arising from their negligence, to the fullest extent permitted by law; and, (C) agree to indemnify, defend ,and hold harmless the City, its elected and appointed officials, and employees from any and all claims for injuries, damages or loss, of any kind whatsoever arising in any way in connection with my access to and use of the Community Center and its amenities.
39. PARENT OR GUARDIAN ACKNOWLEDGEMENT AND CONSENT
    I have read and understand the terms of this Agreement and unconditionally agree to its full terms, waivers and releases on behalf of both myself, and my child or ward, whose name(s) is listed above. All such terms, statements, warranties, notices, representations, waivers and releases fully apply to my child or ward as if I was the participant. I understand that, by signing this Consent, I am giving up important legal rights both on behalf of myself and my child or ward regarding potential rights and claims against the City, if any. I have had sufficient opportunity to read this entire document. I have read and understood it, and I agree to be bound by its terms. I hereby warrant and represent that if I am neither the Child’s Parent nor legal Guardian, I have been granted the expressed authority to execute this Waiver, Release and Assumption of Risk Agreement by, and on behalf of, the Child’s Parent or Guardian. In the event that it is determined I do not have the authority to execute this agreement on behalf of another, I agree that I shall be solely liable for any and all claims, actions, penalties, causes of action, services, fees or similar expense.
41. I acknowledge I have read and understand the above release, waiver & participation agreement and agree to abide by its terms & conditions.

    1. Yes
    2. No
43. Signature
    Please provide your electronic signature above.
44. Date
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46. 1. Receive an email copy of this form.
47. Email address

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48. Submit

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