Gilpin County Community Center 

Parks and Recreaction


(If you pay property taxes in Gilpin County, this qualifies you for resident status)

Minors in the Household also included in this liability waiver:

Household Data

Emergency Contact Information:
Personal Release Statement: By submitting this form to the Gilpin County Community Center, I understand that physical activities, registered classes, leagues and programs may have an element of hazard or inherent danger. I take full responsibility for my actions and physical condition, and for the actions and physical condition of my family members listed above. I agree to be solely responsible for my own safety, and the safety of the minors listed above. I agree to indemnify and hold Gilpin County and its employees harmless from any liability, loss, cost or expense (including attorney's fees, medical and ambulance costs) that I may incur while participating in recreation activities. I give my consent to use any photographs or videotape taken of me, and of the minors listed above, in future promotional or marketing materials.
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