W . A . T . E . R .
Water Activities Touches Everyone’s Road
Open to youth between 13 and 16 years old.  Age 15 an 16  will be eligible for the Lifeguard certification program


  

Participant Information:

  






Gender









 
Parent/Guardian Information
  











 
Emergency Contact Information









Relationship to child:
     



 
I GRANT/GIVE PERMISSION  for my son/daughter to participate in the W.A.T.E.R. Program.  Further more, I GRANT/GIVE PERMISSION to the City of Hartford the right to use, reproduce, assign and/or distribute photographs or likeness, films, videotapes, and sound recordings of myself and/or son/daughter/child) for promotion of the department’s activities, properties, facilities or functions in any public format including but not limited to publication in the department’s website, brochure(s), publication, and/or press release and any materials the department may create.  I understand that such promotion may be disseminated to the public and may be copied or otherwise reproduced.  I hereby release the City of Hartford, its officers, directors, employees, coaches, volunteers, or other agents and departments/divisions from any and all liability from participation in the program and  the photograph or likeness myself/son/daughter/child in such promotion, and from any liability that may arise from the dissemination of such promotion to the public or the use of the promotion by the public.

Check to confim:


       
       


550 Main Street, Room 305
Hartford, Connecticut 06103
  
Website: dfcyr.hartford.gov