Rudy A. Ciccotti Family Recreation Center

Program Registration Request Form

Please complete the entire program registration request form. Completion of the form does not guarantee placement in the program. We will contact you at the phone number provided on the form to confirm your registration and to get your payment information. Please feel free to call us at 518.867.8920 if you have any questions.

Please request only one course and one participant per submission.
All fields are required

Please explain any allergies, medical conditions or other needs of the participant which we should be aware of:

If participating as a minor, please complete the following:

Course Name Session Cost
Payment Options:
Mail to:
Ciccotti Center Program Registration
30 Aviation Road
Albany, NY 12205		 Please call (518) 867-8920 or visit the Ciccotti Center to process your secure registration. Please complete and return Participant Release of Liability.

REQUIRED FOR ALL PROGRAMS: PARTICIPANT RELEASE OF LIABILITY.

In consideration of being allowed to participate in any way in the program, related events and activities, I acknowledge, appreciate and agree that:

1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death and while particular rules, equipment and personal discipline may reduce this risk, the risk of serious injury does exist and,

2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others and assumes full responsibility for my participation; and

3. I willingly agree to comply with the stated and customary terms and conditions of participation. If however I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest official immediately, and,

4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY AND HOLD HARMLESS The Colonie Youth Center, their offices, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers and, if applicable, owners and lessor of premises used to conduct the event (RELEASEES, WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property. WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY AGREEING TO IT, AND ACCEPT FREELY AND VOLUNTARILY WITHOUT INDUCEMENT.

FOR PARENTS/GUARDIANS OR PARTICIPANT OF MINOR AGE: (UNDER AGE 18 AT TIME OF REGISTRATION)

This is to clarify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liability incidents to my minor child’s involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.