Spaces for additional family members appear later in the form.

For good and valuable consideration, the undersigned releases the Dixon Park District; all of its cooperating agencies; and the elected commissioners, administrative officers, and instructors and agents of said parties, from any and all claims of whatever nature for any injury, loss, damage, accident or expense arising from or out of the participation in the Dixon Park District Recreation Program, and further agrees to further indemnify and hold harmless all of said parties above enumerated against claims and for all costs and reasonable attorney’s fees arising out of or in any way connected with the participation in the recreation program. The undersigned hereby releases and agrees to indemnify and hold harmless all of said parties above in regards to person or persons the undersigned includes or invites to participate with them in any activity. In case of inclement weather, the race will be cancelled. Thank you for your donation.