Registration for Kids Vs Cops

User information

• First name
• Last name
• Email

Additional information

• Participant Name
• Birth Date
• Age
• Gender
• Address
• Phone Number
• In case of emergency, please contact (name and phone number)
• If minor - Mother or Legal Guardian's: name, birth date, address, phone, and email.
• If minor - Father or Legal Guardian's: name, birth date, address, phone, and email.
• Please list 3 people (other than parents) allowed to pick up the participant and/or be contacted in an emergency
• How did you hear about this program?
• Special Needs: if you or your child has a disability, impairment or condition that requires medication or other accommodations, please inform the City of Boynton Beach recreation & parks department of your needs before the program begins to ensure that the department is prepared to address them. Once submitted, the department will consider on a case-by-case basis and will attempt to accommodate you or your child within a reasonable amount if time. Does the participant have any special needs/limitations which requires an accommodation to enjoy the program?
• Please list special needs, allergies, and medications.
• GENERAL RELEASE: ON BEHALF OF THE ABOVE, I, THE UNDERSIGNED PARTICIPANT/PARENT/GUARDIAN, in considerations for the CITY OF BOYNTON BEACH through its Recreations & Parks Department providing facilities, instruction, transportation and supervision in the activity for which I/he/she has registered, do hereby (1) Assume all risks (2) Request permission to participate in the activity with full knowledge that said activity could result in damage or injury to me/him/her. I will furnish a birth certificate for the above names upon request by the Recreation & Parks Department; (3) agree to indemnify & hold harmless the City Of Boynton Beach and/or it departments or agents from liability resulting from my/his/her participations in said activity; (4) give the City of Boynton Beach Recreations & Parks Department permission to take photos and use them to publicize programs and use in media correspondence; (5) acknowledge that the event/program/class/course in which I am/my child(ren) is/are partici
• NOTICE TO THE MINOR CHILD’S NATURAL GUARDIAN: read this form completely and carefully. You are agreeing to let your minor child engage in a potentially dangerous activity. You are agreeing that, even if the City of Boynton Beach uses reasonable care in proving this activity, there is a chance your child may be seriously injured or killed by participating in this activity because there are certain dangers inherent in the activity which cannot be avoided or eliminated. By signing this form, you are giving up your child’s right and your right to recover from City of Boynton Beach in a lawsuit for any personal injury, including death, to your child or any property damage that results from the risks that are a natural part of the activity. You have the right to refuse to sign this form, and the City of Boynton Beach has the right to refuse to let your child participate if you do not sign this form. I have read and understand the Notice to the Minor Child’s Natural Guardian.
• The Boynton Beach Police Department request parental consent to share your child’s photo on BBPD social media platform like Facebook, Instagram, X, and Nextdoor. Your child’s personal identifying information, such as their name and address, will NEVER be disclosed.