Parent/Guardian Name: (First)_________________________ (Last)__________________________________
Street Address: ________________________________ Unit/Apt#:__________ Email:___________________________________
City:______________________ State:________ Zip Code:____________ Phone: (____)_______-_______________
Full Name of Participant
First & Last
Date of Birth
MM/DD/YYYY
Resident
or Non Resident
AC #
EX: 6001-1
Activity Name Fee
Res Non Res
$
Res Non Res
$
Res Non Res
$
Res Non Res
$
By registering for any recreation class or activity, you are granting the City of Diamond Bar permission to use your and/or your child’s photograph or likeness, or
that of a pet or personal property, for promotional use in any City related media.
If you or your minor child require special assistance to participate in an activity, class or event, please notify the Parks and Recreation Department at the time of
registration or call (909) 839-7070.
Contract class cancellations must be submitted in writing to the Parks & Recreation Department and made prior to the start of the second class of the session. All
cancellations will incur a $15 cancellation fee.
Community/senior excursion cancellations must be submitted in writing to the Parks & Recreation Department and will only be given when the trip is sold out and
recreation staff is able to resell your ticket. All cancellations will incur a $15 cancellation fee.
Total $
A signed waiver must be submitted at the time of registration. If the participant is 18+ an Adult waiver must be submitted. For
participants under the age of 18 a child waiver must be submitted and signed by the guardian of the child participating in the activity.
Mail form along with payment (check only) made payable to: City of Diamond Bar Attn: Parks & Recreation
Department, 21810 Copley Drive, Diamond Bar 91765
For registration information, contact the Parks and Recreation Department at (909) 839-7070
ACTIVITY REGISTRATION FORM
