Community Education Release made by the undersigned members or participants of
 
                  Class Name:  ______________________
 
 
To St. Louis County Schools, Independent School District No. 2142, a Minnesota municipal corporation, for class held at South Ridge School on or during the period.  I hereby and forever discharge and release St. Louis County Schools, its successors and assigns, from all debts, claims, demands, damages, actions, and causes of actions whatsoever which I may have or may hereafter have as a result of the use of the above-mentioned facility by myself or my child.  I acknowledge that I am aware of the risks and hazards involved in the aforesaid activity. 
 
In witness whereof, I, the undersigned, have executed this release on the day and year appearing after my signature.
 
SIGNATURE_____________________________________________________________DATE_________________
                                        PARENT’S SIGNATURE IF CHILD IS NOT 18 YEARS OLD)
 
 
PARTICIPANT’S NAME_________________________________________________________________________
                       
                       
ADDRESS__________________________________________________ CITY _____________   ZIP___________                        
                       
       
PHONE (HOME)_________________ (WORK)                                                 _(CELL)___________________________
 
 
EMAIL_______________________________________________
 
AGE GROUP:       Preschool (Age 0-5)            Student (GR K-5)                 Student (GR 6-8)                  Student (GR 9-12)
(circle one)            
                                Adult (19-54)                        Senior Citizen (55+)
 
       
 
I GIVE PERMISSION TO USE PHOTOS FOR COMMUNITY EDUCATION PROMOTIONS.   
PLEASE CHECK ONE   _____ YES _____NO.
 
 
 
 
COURSE TITLE                                                     BEGINNING DATE                                                                 FEE
       
_____________________________            _____________________________________          _________________
 
_____________________________            _____________________________________          _________________
 
_____________________________            _____________________________________          _________________

 _____________________________            _____________________________________          _________________
 
 
Make checks payable to: ISD #2142 COMMUNITY EDUCATION
 
 
Mail Registration Form to:          South Ridge Community Education
                                                            6623 Evergreen Lane
                                                            Alborn, MN  55702