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2. Library Program Participant Form
4. In consideration of acceptance into the above referenced City program, I do hereby, for myself, my children, my heirs, executors and assigns, release the City of Bisbee and the officials, officers, agents and employees of the City from liability for any harm, injury or damage, which I, or my minor children, may suffer while participating in the above-described program. This includes all risks that are connected with this activity whether foreseen or unforeseen.
6. I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS RELEASE BY READING IT BEFORE I SIGNED IT. I REALIZE THAT BY SIGNING THIS DOCUMENT I AM GIVING UP LEGAL RIGHTS WHICH I MAY BE ENTITLED.
8. Participant Name*
10. Address*
12. City*
13. State*
14. Zip Code*
16. Home Phone*
17. Work Phone
19. Email Address*
21. Library Program*
23. Signature*

    1. By checking this box and typing my name below, I am electronically signing my application.
25. First Name*
26. Last Name*
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field