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No emails or URLs allowed

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No emails or URLs allowed

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{{ 'BIRTH-DATE' | translate}}

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{{ 'REG-OPTION-GENDER-ERROR' | translate}}

{{ 'PRIMARY-PHONE' | translate}}

{{ 'PROVIDE-VALUE' | translate}}

{{ 'NOT-VALID-PHONE-NUMBER' | translate}}

{{ 'EMAIL' | translate}}

{{ 'EMAIL-CONFIRM' | translate}}

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{{ 'ENTER_VALID_EMAIL' | translate }}

{{ 'SAME-EMAIL' | translate}}

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{{ 'STREET_2' | translate}}

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{{ 'PLEASE-PROVIDE-VALUE' | translate}} {{ 'VALID-ZIP' | translate}}

{{ 'CITY' | translate}}

{{ 'PLEASE-PROVIDE-VALUE' | translate}}

{{ 'STATE/REGION' | translate}}

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Please read this form carefully and be aware that in registering yourself or your minor child/ward for participation in Town of Fountain Hills programs, you will be waiving and releasing all claims for injuries you or your child/ward might sustain arising out of said programs.

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization.  COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact.  As a result, federal, state, and local governments and federal and state health agencies recommend physical distancing and have, in many locations, prohibited the congregation of groups and people.

            The Town of Fountain Hills (Town) has put in place preventative measures to reduce the spread of COVID-19; however, the Town cannot guarantee that you, your children, or any other person, will not become infected with COVID-19.  Further, attending Town sponsored activities could increase your risk and your child or children’s risk of contracting COVID-19. 

            By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child or children and I may be exposed to or infected by COVID-19 by attending Town activities and that such exposure or infection may result in personal injury, illness, permanent disability, and death.  I understand that the risk of becoming exposed to or infected by COVID-19 at Town activities may result from the actions, omissions, or negligence of myself and others, including but not limited to Town employees, volunteers, and program participants and their families. 

            I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child or children or myself, including, but not limited to, personal injury, disability, death, illness, damage, loss, claim, liability, or expense or any kind, that I or my child or children may experience or incur in connection with my child or children’s attendance at Town activities or programming.  On my behalf and on behalf of my child or children, I hereby release, covenant not to sue, discharge, and hold harmless and indemnify the Town, its employees, agents, and representatives, of and from any and all claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto.  I understand and agree that this release includes any claims based on the actions, omissions, or negligence of the Town, its employees, agents and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Town program. 

Media Disclaimer: By participating in programs and special events, a participant expressly grants the Town of Fountain Hills the royalty free license and complete release to take photos and videos of themselves and their children for publication in the program brochure, web site and additional uses as the Town deems necessary unless the registrant or participant expressively files with the Town a written objection as to photos or videos of themselves and/or their children.

 

I have read and fully understand the program details and waiver and release of all claims.

 

Sorry no refunds

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Please select the time you would like to start. We will be starting groups of 150

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SKU# {{product.sku}}
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{{ 'PAYMENT-ERROR' | translate}}

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{{customFee.description}} : {{customFee.price | currency:"$":currency.decimal}}
{{ 'PROCESSING_FEE' | translate }} : {{cart.fee | currency:"$":currency.decimal}}
{{ 'SALES_FEE' | translate}} : {{cart.totalSales | currency:"$":currency.decimal}}
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{{ 'SUBTOTAL' | translate}} : {{cart.subtotalLottery | currency:"$": currency.decimal}}
{{customFee.description}} : {{customFee.price | currency:"$": currency.decimal}}
{{ 'PROCESSING_FEE' | translate }} : {{cart.lotteryFee | currency:"$":currency.decimal}}
{{ 'TOTAL_CHARGE_IF_SELECTED' | translate}} : {{cart.lotteryTotal | currency:"$": currency.decimal}}
{{ 'IF_SELECTED_CHECKOUT' | translate:cart}}

{{ 'PAYMENT-ERROR' | translate}}

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{{ 'NO-PAYMENT-REQUIRED' | translate }}
{{ 'MASTERPASS-TAGLINE' | translate }}

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{{ 'REQUIRED' | translate }} {{ 'PAYMENT-NAME-MIN-LENGTH' | translate }}

{{ 'CARD-NUMBER' | translate }}
{{ 'EXPIRATION' | translate }}
{{ 'SECURITY-CODE' | translate }}
{{ 'POSTAL-CODE' | translate }}
{{ 'CARD-NUMBER' | translate }}
{{ 'EXPIRATION' | translate }}
{{ 'SECURITY-CODE' | translate }}
{{ 'POSTAL-CODE' | translate }}

{{ 'REQUIRED' | translate }}

{{'SHIPPING-ADDRESS' | translate}}


{{ 'FIRST-NAME' | translate }}

{{ 'REQUIRED' | translate }}

{{ 'ENTER_VALID_EMAIL' | translate }}

{{ 'LAST-NAME' | translate }}

{{ 'REQUIRED' | translate }}

{{ 'ENTER_VALID_EMAIL' | translate }}

{{ 'COUNTRY' | translate }}

{{ 'REQUIRED' | translate }}

{{ 'POSTAL-CODE' | translate }}

{{ 'REQUIRED' | translate }}

{{ 'ENTER_VALID_EMAIL' | translate }}

{{ 'STREET' | translate }}

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{{ 'ENTER_VALID_EMAIL' | translate }}

{{ 'CITY' | translate }}

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{{ 'EMAIL' | translate }}

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{{ 'ENTER_VALID_EMAIL' | translate }}

{{ 'REGION' | translate }}

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{{ 'PAYMENT-INFORMATION' | translate }}


{{ 'NAME-ON-CARD' | translate }}

{{ 'REQUIRED' | translate }} {{ 'PAYMENT-NAME-MIN-LENGTH' | translate }}

{{ 'CARD-NUMBER' | translate }}

{{ 'REQUIRED' | translate }} {{ 'INVALID-CREDIT-CARD-NUMBER' | translate }}

{{ 'EXPIRATION' | translate }}

{{ 'REQUIRED' | translate }} {{ 'INVALID-EXPIRATION-DATE' | translate }}

{{ 'SECURITY-CODE' | translate }} (CSC/CVC/CVV)

{{ 'REQUIRED' | translate }} {{ 'INVALID-SECURITY-CODE' | translate }}

{{ 'REQUIRED' | translate }}

{{ 'PAYMENT-INFORMATION-MESSAGE' | translate }}


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