Return to 112 Main Street, Dobbs Ferry, NY 10522
Registration Form
Name __________________________________ Address ____________________________________________
Phone Number ________________ Date of Birth __________ Age ________ Sex _________ Grade _________
Emergency Contact __________________________ Phone Number ___________________________________
Program: BIKE RODEO Fee: $ FREE
As a participant in the above program, I recognize and acknowledge that there are certain risks of physical injury and I agree to assume the full risks of any injuries, damages or loss which I or my child may sustain as a result of such participation. I further understand that the Village of Dobbs Ferry does not provide accidental medical coverage and it is my responsibility to provide appropriate coverage. I agree to waive and relinquish all claims and hold harmless the Village of Dobbs Ferry, Parks and Recreation Department, its officers, agents and employees from any and all claims
______________________________________________ _________________________ Signature Date
For more information, please call 693-0024
