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2. 
3. Dive In Movie Registration Form
   Space is limited so pre-registration is required to attend this event. Please be sure to list any children attending and include their ages. We ask that their be 1 adult chaperone per 4 children attending.
5. First Name*
6. Last Name*
8. Address*
10. City*
11. State
12. Zip Code
14. Phone Number*
15. Email Address*
17. Movie*
    -- Select One --July 27- The Little Mermaid
19. Child's Name #1
20. Child's Age
21. Are you the Child's Parent/Guardian?

    1. Yes
    2. No
23. Child's Name #2
24. Child's Age
25. Are you the Child's Parent/Guardian?

    1. Yes
    2. No
27. Child's Name #3
28. Child's Age
29. Are you the Child's Parent/Guardian?

    1. Yes
    2. No
31. Child's Name #4
32. Child's Age
33. Are you the Child's Parent/Guardian

    1. Yes
    2. No
35. Child's Name #5
36. Child's Age
37. Are you the Child's Parent/Guardian

    1. Yes
    2. No
39. Child's Name #6
40. Child's Age
41. Are you the Child's Parent/Guardian

    1. Yes
    2. No
43. Rules and Regulations
    1. You may not bring your own raft or float however, children may wear a coast guard approved personal flotation device. Pool noodles will be provided for your use.
45. 2. All children 15 and under must be accompanied by a parent.
47. 3. Children 8 and under must have a parent within arm's reach in the pool at all times.
49. 4. Patrons are permitted to bring their own food and drinks. No alcohol is allowed. The Berea Recreation Center will also be selling food and refreshments.
51. 5. Patrons must pre-register with the Berea Recreation Center prior to the event. Walk-ins the day of will only be allowed in if there is space.
53. 6. Please bring your own towel.
55. 7. Patrons that do not plan on swimming may bring a chair or blanket.
57. RELEASE:
    The undersigned shall release, indemnify and hold the City of Berea harmless from any and all claims, liabilities, losses and causes of action which many arise out of participation of the undersigned or the undersigned’s minor children at the City of Berea Dive In Movie. This includes all other acts for omissions to act on the part of the undersigned including any person acting for or on his/her own behalf, and further releases, indemnifies and holds the City of Berea harmless against any orders, judgments, or decree which may be entered, and from and against all costs, attorneys’ fees, expenses and liabilities incurred in the defense of such claims. *By checking the box below, you understand and have read the rules and regulations and further understand that you will be asked to leave the event in the case of a breach or broken rule by you or someone in your care.
59. By checking this box, you understnad and have read the rules and regulations and further understand that you will be asked to leave the event in the case of a breach or broken rule by you or someone in your care.*

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61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit

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