2010 Fall & Winter Leisure Times will be in the August 26th edition of the Central Virginian Newspaper. Brochures will also go home with children enrolled in elementary school and the middle school. Call us at 967-4420 if you want to be put on the mailing list to have each issue mailed directly to your home.
LCPR Home Page

Kids & Teen Scene

Kids & Teen Sports

TeenQuest Teen Center

Fitness & Exercise

Educational & Enrichment

Bracketts Farm Living History

Travel

Special Interest

Fun For The Family


Play Local

Community Happenings

League Schedules

LCPR Rewards Program

Meet The Staff

Past Special Events


Leisure Times Brochure

For Your Information

Facilities & Parks

County Home Page

PARTICIPANT REGISTRATION FORM
Complete and submit this form to sign up for activities. After you submit it,
you must also print, sign, and return the WAIVER form to complete the process.


Pre-registration is required for all activities. Registration deadlines are three days before activity begins unless otherwise stated. Late registrations are possible only when there are openings and late fees may apply.

The Louisa County Department of Parks and Recreation does not provide medical coverage or insurance for individual participants. All medical insurance protection must be provided by the parents or participant. In the event of an emergency, I hereby give my consent for the program supervisor of the Parks and Recreation Department to arrange for medical treatment or Emergency Room treatment by a physician on staff. I also hereby give my consent and approval for my son/daughter/self to participate in this activity sponsored by the Louisa County Department of Parks and Recreation. I will not hold Department Personnel, Instructors, School Personnel, or Volunteers responsible in case of accident or injury as a result of my/my child's participation in this program. I understand the risks involved with this activity and know that my child is/I am physically able to participate in this program.

We are no longer able to register you for a program without receiving payment.
You may submit this registration online, but you will not actually be registered until your payment is received.


PARTICIPANT REGISTRATION FORM
Parent/Guardian/Participant Name:
Mailing Address:
City and State:
Zip Code:
E-Mail Address:
Home Phone:
Work Phone:
 
Participant 1 First/Last Name: /       M F
Birthdate (mm/dd/yy):       T-Shirt size if applic:
 
(Youth S M L, Adult S M L X)
School Attends:       Grade:
Program Registering For:       Starts:       Fee:
 
Participant 2 First/Last Name: /       M F
Birthdate (mm/dd/yy):       T-Shirt size if applic:
 
(Youth S M L, Adult S M L X)
School Attends:       Grade:
Program Registering For:       Starts:       Fee:
 
Participant 3 First/Last Name: /       M F
Birthdate (mm/dd/yy):       T-Shirt size if applic:
 
(Youth S M L, Adult S M L X)
School Attends:       Grade:
Program Registering For:       Starts:       Fee: