b'SPECIAL EVENTS special events ___________Discover ___________ ___________________________________________________________________ EMAIL FEE TOTAL ___________________ OFFICIAL USE REGISTRATIONMANY PROGRAMS FILL FAST, REGISTER EARLY! ______________________________________________________________________________________________________________________RETURN COMPLETED FORM WITH FEE TO: Kearney Park and Recreation Dept., P.O. Box 1180, Kearney, NE 68848//Phone: 237.4644Voice/TDD 233.3215___________________________________________________________________________ AUTHORIZED SIGNATURE ACTIVITY NAME AND DATE(include time, location, level or swim lesson # if applicable) HIP HOP ___________ Mastercard Please designate any special needs you or your child may require . _________________ ZIP PARTICIPANT RELEASE STATEMENT: We understand the activities that my family has enrolled in, and I hereby give my permission and consent for their participation.Furthermore, I recognize that proper care of equipment, fields and adequate supervision will be provided, but that inherent in these activities is a degree of an assumptionof risk. I do hereby absolve, release and agree to hold harmless the City of Kearney, its sponsors, leaders, agents and volunteers from liability claims in case of accidents toall family members enrolled in these programs. PHOTO PERMISSION: We the parents or participating individual, do hereby grant permission for pictures and video to be used in publicity or brochures related to the Cityof Kearney Park & Recreation Program . PARENT /GUARDIAN/ADULT PARTICIPANT SIGNATURE:______________________________________________________________DATE:_______________________LETTER HUNTSATURDAY, APRIL 16 YAPPY HOUR!HARMON PARK|9:00am - 5:00pm|FREEHip Hop your way through Harmon Park, when you find an egg write down the letter you see . Once you have alltheletters,unscramblethemtomakeaphrase.THURSDAYS__________________________________________ Sendthephrasetokdavidson@kearneygov.orgbyApril 21, June 16, & August 18|5:30-7:00pmprogram registration Method of Payment: Cash Enclosed ___________Check Enclosed ___________Make Checks Payable to City of KearneyVisa Credit Card # _______________________________________________________Exp. Date ______________________ CCV# ____________________STATE CITY NOTE: YOU WILL NOT BE MAILED A WRITTEN RECEIPT. ASSUME THAT YOU ARE IN THE ACTIVITY UNLESS OTHERWISE NOTIFIED.Monday, April 18 by 5:00pm and be entered into win aMEADOWLARK NORTH DOG PARKfun festive basket! FREE EVENT _____________________SHIRTSIZEMeet other dogs and dog owners, free treats for WORK PHONE PRIMARY PHONE ______________________________________________ dogs, free refreshments for dog owners, guest 3 DIGIT CODE ON BACK OF CARD SCHOOLspeakers & more!SATURDAY, APRIL 30__________________________________GRADE11:00am-1:00pm| FREE EVENT! FAMILY FUN!Does the participant need any special accommodations in order to fully participate? NO *If yes, a follow up call from KPR will be made. ___________ DATE OF BIRTHWalk begins at the Harmon Park Activity CenterReadpagesofAnd ThenComesSummerby Tom Brenner, as you walk through Harmon Park engaging in fun activities that keep you guessing whats next in the story. Enter for a chance to win a copy of the book at the end of the walk .*Its a day of free family fun, filled with music, art, theater,dance,culture,andmore!JoinKearneyCulturalPartners ____________________ DATE OF BIRTH______________________________________________________________________________________ ADDRESS AGE M/FforaFamilyArtsFestivalbeforeoraftertheStorybookWalkbetween11am-3pmatHarmonPark.MoreinfoatKearneyCultruralPartners.com.______________________________________________________________PRIMARY FAMILY CONTACT NAME ___________ PARTICIPANTS NAMESATURDAY, MAY 710:00am-approx. 2:00pmHORIZON MIDDLE SCHOOL (JOE GREENO FIELD)SUNDAY, MAY 1 915 West 35th Street*Boys & Girls Age Divisions:8-9, 10-11, 12-131:00pm-3:00pm| FREE EVENT (age as of 12/31/22)Kearney Trail System The event is FREE, however, participants must pre-All ages and families welcome! register by completing an entry form by May 5.Entry Participate for a chance to win a 2022 Familyforms are available at the Park and Recreation Office. YES* Swimming Pool Pass and other prizes!A recreational track & field meet for boys and girls.Go to www.kearneyrec.org The top four in each age group will advance to the Championship Meet in York on June 11 .Join your for instructions and a map!friends and sign up now!PG.4 PG.37'