Lila Creative Community  Registration Form

Name *
Name
Address
Address
Phone
Phone
if different than above
Date of Birth
Date of Birth
minors only
Returning or New?
$
Please read carefully before signing: The undersigned agrees to hold LilA Creative Community and any employees, or volunteers thereof harmless from any claim for injury or accident to the above named arising out of or in any way connected with the named activity.  In case of of an accident arising out of the named activity, medical assistance may be administered to the person named herein.  Registration form will act as medical release.  I understand that no medical insurance is provided, and that staff are not medical professionals and are not trained to diagnose, monitor or treat medical conditions, whether pre-existing or caused by participation in named activity.  I also understand that LilA Creative Community reserves the right to use any photos or videos of participants taken by our staff as promotional material for future brochure publications, flyers, web site postings, and any other media opportunity, and I understand I will not receive compensation for the use of any photos or videos.  If participant is under 18, parent or guardian must sign release.
Date
Date