Class Limit: 20
$75 for 4 weeks
January 9, 16, 23, 30

Youth Agility

Participant Name:*
Participant Age (In Years):*
Participant Phone Number:*
I will submit my $75 payment today:*
I understand and agree to the liability waiver below.*

Liability Waiver for Participation
In consideration of your accepting this entry and/or my or my child(ren)’s participation in an event, program, or activity, I understand that the event, program, or activity for which I or my child(ren) intends to participate may have some inherent risk of injury because of the activity. As a participant or on behalf of my child(ren), I agree that the Haven Recreation Board / City of Haven and their employees and representatives shall not be held responsible for any illness or injury to person or damage to property resulting from my or my child(ren)’s participation in a Haven Recreation / City of Haven event, program, or activity. I further grant permission for Haven Recreation / City of Haven to use my (or my child’s) photo or video for promotional purposes. I hereby, for myself, my child, my heirs, executors, and administrators, waive and release any and all rights and claims for damages my child(ren) or I may have against Haven Recreation Board, City of Haven, or USD #312, and the employees, representatives, successors, and assigns of these entities for any and all injuries suffered by myself or my child(ren) at any events, programs, or activities sponsored by these entities. I understand I am responsible for my and my child(ren)’s own medical insurance. Parent or Legal Guardian must sign for any child, 18 & under, entering the program. 

Payment Options:
  • You may drop cash (in an envelope with your name on it please!), check, or money order through the slot on the City Office door at 120 S. Kansas Avenue. 
  • You may call 620.465.3618 to pay over the phone by credit card or e-check.
  • You may pay online here.  For Agency / Ref, please list the participant's last name and the activity you're registering for (i.e. Washington - Learners).  If you encounter difficulty, call 620.465.3618 for assistance.
Please note that a participant will not be considered registered until the completed form and full payment have been received!