u:\front desk\forms, flyers, events, etc\registration forms\reg form complete feb 2013 revised.docx
Requests to change bank account information must be received by the 9th of the month we
process the EFT. Prices are subject to change.
Bank Name _____________________________________________ Routing # ______|______|______|______|______|______|______|______|______
Account # ______|______|______|______|______|______|______|______|______|______|______|______|______|______|______|______|______|_____
Please attach a copy of a voided check (checking) or a bank letter.
Print Member Name ____________________________________________________________________________
Signature of Account Holder _________________________________________________________ Date__________________
Please cancel my Electronic Funds Transfer (EFT) contract agreement for my membership at the Paul
stock Aquatic and Recreation Center as per the terms of the contract. I realize that I am still
responsible for any payments remaining until my current contract expires.
Print Name ____________________________________________________________________________
Signature of Primary Member ________________________________________________________ Date _________________
Please read this waiver carefully, and let us know if you have any questions or concerns.
When registering yourself, your spouse, or your minor child/children for membership and participation in activities and
programs sponsored by the Paul Stock Aquatic & Recreation Center you will be waiving and releasing all claims for injuries
you, your spouse, or your minor child/children might sustain arising out of the use of the facility mentioned above.
I hereby give my consent for myself, spouse or minor child/children to participate in recreational activities sponsored by the
Cody Parks & Recreation Department in Cody, Wyoming, during any session of the recreation program. I HEREBY RELEASE
THE SHOSHONE RECREATION DISTRICT, RECREATION DIRECTOR, RECREATION STAFF AND BOARD OF
DIRECTORS, THE CODY PARKS & RECREATION DEPARTMENT, THE CITY OF CODY, AND ALL CITY STAFF
ASSOCIATED THEREWITH FROM ALL LIABILITY, INCLUDING CLAIMS AND SUITS AT LAW OR IN EQUITY FOR
ANY INJURY FATAL OR OTHERWISE, INCLUDING BUT NOT LIMITED TO CLAIMS FOR NEGLIGENCE, while
participating in any of the recreation activities and understand that I will be fully responsible for any damage or injuries
incurred by the participant while involved in any Recreation Department activity.
Also, I hereby pledge to provide positive support, care and encouragement for my fellow competitors and league officials by
following this Code of Ethics. I will encourage good sportsmanship by demonstrating positive support for all players, coaches
and officials at every game. I will treat other players, coaches, fans and officials with respect regardless of race, sex, creed
or ability. I understand that I am participating in a recreation activity and agree not to use profane language or engage in
‘trash talking’ at any time. I will lead, by example, in demonstrating fair play and sportsmanship to all my fellow
competitors. I understand that the officials are there for my benefit and will agree not to direct any profane or threatening
actions toward them (either verbal or physical). I understand that any violation of this code shall be cause for the Shoshone
Recreation Board & Cody Parks & Recreation, in executive session, to deal with any behavior and/or conduct that are
considered by the Board to be disruptive, destructive, and/or illegal. Behavioral problems may result in expulsion from the
program without reimbursements.
The Shoshone Recreation District/Cody Parks & Recreation Department does not provide any medical insurance or personal
liability to cover participants during an activity. This is the responsibility of each individual involved in any recreation
activity.
NOTICE: The City of Cody reserves the right to take and use photographs of individuals using the Cody
Recreation Center and/or participating in programs sponsored by the City of Cody. Such photographs are the
property of the City of Cody, and may be used in brochures, advertisements and other promotional materials.
All purchased memberships are non-transferable and non-refundable. All purchases are subject to our return
policy. Prices are subject to change.
Print Name _____________________________________________________________________________________________
Signature ______________________________________________________________________ _______ Date: _________________
Paul Stock Aquatic and Recreation Center
Cody Parks, Recreation and Public Facilities
1402 Heart Mountain Street
P.O. Box 2200 Cody, Wyoming 82414
(307) 587-0400
E
LECTRONIC
F
UNDS
T
RANSFER
(EFT)
B
ANK
A
CCOUNT
C
HANGE
E
LECTRONIC
F
UNDS
T
RANSFER
(EFT)
C
ANCELLATION
REGISTRATION AND INFORMATION UPDATE
FORM
M
EMBERSHIP AND
A
CTIVITY
W
AIVER
Membership
Expiration Date
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signature
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