GLOBAL SALES RECEIPT

Receipt # 692483
Payment Date: 08/19/22
Household: 25744

Elgin Parks and Recreation Jamcy Casanova Saldana

100 Symphony Way 700 E State St
Elgin, IL 60120 Elgin IL 60177
Phone: (847)531-7000 jamcycasanova1314@gmail.com

Activity Enrollment Details: 403105-04 (Level 2 (Primary Skills) - Sundays @ 9:00am)

New Fees Total Fees New Paid Total Paid Amount Due
Enrollee Name: Jenissa Casanova 85.00 85.00 85.00 85.00 0.00
Enrollment Date: 08/19/2022
Enrollment Status: Enrolled

Meeting Details: This Class meets from 08/21/2022 to 10/09/2022 at 9:00 am to 9:40 am on Su
Class Location: Adventure Island Leisure Pool

Special Questions: Do you have any special needs requirements? If yes, email parksandrec@cityofelgin.org. (Yes or No
answer is Required): no

New Pass Registration: PSL (Private Swim Lesson)

Pass Holder: Jamcy Casanova Saldana New Fees Total Fees New Paid Total Paid Amount Due
Pass Number: 29832 54.00 54.00 54.00 54.00 0.00
Valid Dates: 08/19/2022 to 08/19/2023
Pass Visit Info: Number of Visits: 2
Special Questions: Day and Time Preference: Sunday's afternoon
Instructor Preference: Spanish Speaking Instructor
What is the best phone number to reach you? .

Processed on 08/19/22 @ 6:55 pm by ramirez_j Total New Fees 139.00

Discount Applied 0.00
Total New Taxes 0.00
Total Due 139.00

Total Fees Paid 139.00

Total Taxes Paid 0.00
Total Paid 139.00

Household Balance Information

Overall Household Balance Due 0.00

Payment of: 139.00 Made By:CREDIT CARD Auth: 145447 Card#: xxxxxxxxxxxx4035 With Reference:

Page # 1 of 4
GLOBAL SALES RECEIPT

Receipt # 692483
Payment Date: 08/19/2022
Household: 25744

Main Contact: Jamcy Casanova Saldana

Registrant Narme: Jenissa Casanova

Activity: Level 2 (Primary Skills) - Sundays @ 9:00am

DatesL 08/21/22 to 10/09/22
Times: 9:00 am - 9:40 am

WAIVER: I hereby agree and understand, in exchange for good and valuable consideration, including but not limited to the
services and access provided with my membership, the receipt and sufficiency of which are hereby acknowledged, that I (or to
the extent I am signing on behalf of any of my family members including but not limited to minor children) assume and
acknowledge the risks inherent in the above-mentioned activities, and further agree to the fullest extent permitted by law to
indemnify, defend, waive and hold the City of Elgin, its officials, officers, employees, agents, independent contractors or any
other related person or entity, harmless from and against any and all liability, claims for damages, causes of action, judgments
or suits to which I or my family members, heirs or assigns may otherwise be entitled, resulting from my or my family members
membership and/or participation in the above program(s).

I further understand that no hospitalization, health or accident insurance coverage has been provided with this registration.

I hereby consent to any above-listed minor or other persons participation in any programs provided for hereby and consent to
emergency medical treatment for any such minor or other person. I further hereby warrant and represent that I have legal
parental or other lawful authority to so consent and register any such aforementioned minor or other person. I further warrant
and represent that I am fluent in the English language and have read and understand all of the provisions of this form. To the
best of my knowledge, there are no physical or other conditions which may interfere with my participation or the participation of
any minor or other person for whom I am signing this waiver and registration in this program or which may unreasonably
endanger any other person. I also acknowledge and hereby agree to abide by the City of Elgin's refund/cancellation policy. In
that event that the duty to defend provisions of this paragraph are invoked, counsel for the City of Elgin's defense shall be of the
choosing of the City of Elgin. The provisions of this waiver shall survive any termination and/or cancellation of any affected
persons membership.

In the event that this waiver is submitted unsigned or altered, registration in the above mentioned activity will not be allowed.

Page # 2 of 4
GLOBAL SALES RECEIPT

Receipt # 692483
Payment Date: 08/19/2022
Household: 25744

Page # 3 of 4
GLOBAL SALES RECEIPT

Receipt # 692483
Payment Date: 08/19/2022
Household: 25744

08/19/2022

Jamcy Casanova Saldana

700 E State St
Elgin, IL 60177

Private Swim Lesson

WAIVER: I hereby agree and understand, in exchange for good and valuable consideration, including but not limited to the
services and access provided with my membership, the receipt and sufficiency of which are hereby acknowledged, that I (or to
the extent I am signing on behalf of any of my family members including but not limited to minor children) assume and
acknowledge the risks inherent in the above-mentioned activities, and further agree to the fullest extent permitted by law to
indemnify, defend, waive and hold the City of Elgin, its officials, officers, employees, agents, independent contractors or any
other related person or entity, harmless from and against any and all liability, claims for damages, causes of action, judgments
or suits to which I or my family members, heirs or assigns may otherwise be entitled, resulting from my or my family members
membership and/or participation in the above program(s).

I further understand that no hospitalization, health or accident insurance coverage has been provided with this registration.

I hereby consent to any above-listed minor or other person's participation in any programs provided for hereby and consent to
emergency medical treatment for any such minor or other person. I further hereby warrant and represent that I have legal
parental or other lawful authority to so consent and register any such aforementioned minor or other person. I further warrant
and represent that I am fluent in the English language and have read and understand all of the provisions of this form. To the
best of my knowledge, there are no physical or other conditions which may interfere with my participation or the participation of
any minor or other person for whom I am signing this waiver and registration in this program or which may unreasonably
endanger any other person. I also acknowledge and hereby agree to abide by the City of Elgin's refund/cancellation policy. In
that event that the duty to defend provisions of this paragraph are invoked, counsel for the City of Elgin's defense shall be of the
City of Elgin's choosing. The provisions of this waiver shall survive any termination and/or cancellation of any affected person's
membership.

In the event that this waiver is submitted unsigned or altered, registration in the above mentioned activity will not be allowed.

Signature: ____________________________________________________

Page # 4 of 4