Pittsburg • 2019 Recreation Guide

28 Registration CITY OF PITTSBURG RECREATION 65 Civic Drive Pittsburg, CA 94565 REGISTRATION FORM Adult Payee Information (Please Print) r Pittsburg Resident r Non-Resident First Name Last Name Address City Zip Phone ( ) Mobile Carrier E-Mail Date of Birth PARTICIPANT NAME BIRTHDATE M/F ACTIVITY NAME DATE(S) TIME FEE CONSENT & RELEASE I hereby certify that I am the parent/legal guardian of the above named child/participant and hereby permit him/her to participate in the above program sponsored by the Recreation Department. Further, I hereby release the City of Pittsburg , Recreation Department, the Pittsburg Unified School District, its officers, agents, employees and independent contractors from any and all liability, demands or claims for the loss or damage which may be sustained by the above named participant (s) while participating in this program. I understand that the City of Pittsburg does not provide accidental injury insurance for participants in this program. Also, I consent to allow medical treatment to the above participant in case of emergency and understand that I am responsible for all cost incurred for such treatment. I give consent to the City of Pittsburg or any other media agency to photograph or video the above-named participant. I understand that these images may be used for brochures, newspapers or other forms of media and that I will not receive any compensation for such use. Parent/Guardian Signature Date ONLINE REGISTRATION Register at pittsburgca.gov Recreation-Register for Classes • Set up your personal account • Search your favorite activity • Register online with our secure system Easy, Convenient, Time-Saving, Eco-Friendly WALK-IN REGISTRATION Register at this location for: Register at this location for: Parks, Facilities, Fields & Programming Buchanan Park, Buchanan Swim Center 300 Presidio Lane, Pittsburg 94565 4150 Harbor Street, Pittsburg 94565 (925) 252-4890 (925) 439-4841 REGISTRATION Pre-registration is required and is on a first-come, first-served basis for participation in programs. Refunds will be issued if program/class is full. In event of full class, your name will be placed on a waiting list. Please note: We do not accept registration or reservation over the phone or fax. Many classes fill early. Fees must be paid in full at time of registration. Classes are subject to cancellation if class minimum is not reached. For your convenience, if paying by check, you can drop your registration form at our outdoor drop box located at the Buchanan Swim Center, 4150 Harbor Street REFUNDS/TRANSFERS The City of Pittsburg will arrange transfer to another class/activity or arrange a refund. Customer requested refunds or transfers must be not later than 3 business days prior to the first day of class. NO refunds after class has started. PLEASE NOTE: If you are paying by credit card or debit card, a non-refundable convenience fee of $1.00 per transaction will be charged. For issues after hours, call Park Patrol: (925) 382-5098

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