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AGE Seniors new participant? Y N

Part icipant Agreement Fitness TENNIS • YOGA • WALKING 1) I verify that I have consulted with my doctor and have June 22, 2012 permission to participate in CityParks Seniors Fitness, admin­istered by City Parks Foundation (CPF). I understand April 30 - and assume the risk incidental to any of the activities I will participate in, and I release, and agree to hold harmless CPF, The City of New York / Parks & Recreation and any other sponsors and the parents, subsidiaries, agents, officers, and employees thereof from any and all liabilities resulting from such causes. 2) During the time of my participation, I hereby grant CPF, its employees, and its agencies full authority to take whatever actions they consider to be warranted for the protection of my health and safety. In addition, I also hereby release each of them from any liability from any such decision and actions taken by them forthwith. The authority shall include the right to obtain, and without further consent, appropriate medical services and treatment. 3) I grant CPF, the City of New York / Parks & Recreation and its subsidiaries, the right to videotape, film, and photograph me, and the right, in perpetuity, to use my FREE name, likeness, bio­­graphical information and voice in all LESSONS forms of media (including the internet) in connection with for adults ages 60+ the advertising and promotion of CPF and/or the City PROMOTING HEALTHY of New York / Parks & Recreation. LIFESTYLES IN NYC P ARKS Signed SUPPORTED BY Zwicker Electric; Council under the Leadership of Christine C. Quinn; NYC

Date SPRING 2012 Olmsted Center Flushing Meadows Park, NY 11368 City Parks Foundation Parks City Council Member Jessica Lappin.

IN COOPERATION WITH

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Learn a new activity and make new friends in your neighborhood park.

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or visit or SIGNATURE SPONSOR 11368 NY Park, Meadows Flushing Center Fitness,Olmsted Seniors Foundation Parks City to: mail and application attached the complete register, To /Woodlawn Cortlandt Van Greenbelt Park Greenbelt STATEN ILAND Park Oxford South Park Marine Park Kaiser BRONX Park • Jefferson Thomas • Park Jay John Flushing Meadows Corona Park • Park Corona Meadows Flushing YOGA INSTRUCTION FITNESS WALKS TENNIS LESSONS www.CityParksFoundation.org

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