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Home My WebLink About256796 03/29/16 ! CITY OF CARMEL, INDIANA VENDOR: 370455 ONE CIVIC SQUARE STEVE GONZALES CHECK AMOUNT: $*********5.00* CARMEL, INDIANA 46032 1747 ASHTON LANE CHECK NUMBER: 256796 9r,iTON�. MASON MI 48854 CHECK DATE: 03/29/16 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 1096 4358400 200062203 5.00 REFUNDS AWARDS & INDE =' Receipt#2000622.003 Page 1 of 3 I Monon Community Center East MAR 21 2016 �/i� j� �r r;#2000,622 D03- g Buildin :�. �� ---�—��J � `M ar ]b, 2Oy16a:25y P� � 1235 Central Park Dr. East Carmel, IN 46032 Phone: (317) 848-7275 FAX: -- Carmel * Clay Email. info@carmelclayparks.com NATIONAL GOLD MEDAL WINNER `g � GONzaLES AND ACCREDITED AGENCY 1747 ASH�TO,NLANEr,.: MASON�MI'"4'88-5�4�` �. Prepared By: amandaj_ Customer ID: 40825 Primary phone: (616) 350-3659, Secondary phone: -- Refund Summary check.< ("$5.0 heck # Total Received: ($5.00) Total Refund: ($5.00) Transactions Customer Description Item Unit Qty Fee Charge Steve Gonzales MCC Spring Open:-U2300 RR#367001-06 Activity Each 1.00 $25.00 ($25.00) 1747 Ashton Lane Action:Transfer Out Fee Mason,MI 48854 Withdrawal Date: Mar 16,2016 Primary phone:(616)350- 3659 Meets: March 19, 2016 Email: Saturday from Noon to Spm wreckdiverl@wowway.com Location: ID:40825 Gymnasium A at Monon Community Center West Building Steve Gonzales MCC Spring Open: Open Singles RR#367001-08 Activity Per Seat 1.00 $35.00 $35.00 1747 Ashton Lane Action:Transfer In Fee Mason,MI 48854 Enrollment Effective Date: Mar 16, 2016 Primary phone:(616)350- Under Per Seat 1.00 $15.00 ($15.00) 3659 Meets: March 19, 2016 2000 Email: Saturday from 3pm to 6pm Rating wreckdiverl@wowway.com _Location:- Discount _ ID:40825 Gymnasium A at Monon Community Center West Building �b \ qr-'\ Total Charges ($5.00) Tiotal Pay meints�f'(�$75�®U�`- 3y tL � ) . �u i Balance $0 Activity Waiver Z-Ai Le Waiver for:Steve Gonzales Carmel Clay Parks & Recreation Waiver and Release On my behalf and on behalf of my heirs and assigns, I HEREBY RELEASE, WAIVE, DISCHARGE, COVENANT NOT TO SUE AND AGREE TO HOLD HARMLESS THE CARMEL/CLAY BOARD OF PARKS AND RECREATION, CARMEL CLAY PARKS & RECREATION, CITY OF CARMEL, CLAY TOWNSHIP, ITS AND THEIR OFFICIALS, OFFICERS, PASSHOLDERS, INDEPENDENT CONTRACTORS, EMPLOYEES AND VOLUNTEERS (the ?Releasees?), from any and all claims or liability for personal injury or property damage my child and/or I may https://anprod.active.com/carmelclayparks/servlet/processReceiptPayment.sdi 3/16/2016 Receipt#2000622.003 Page 2 of 3 ; cause or suffer directly or indirectly arising out of or relating in any respect to participation in a program, event, service or facility provided by or made available through Carmel Clay Parks & Recreation. This waiver and release of all claims, demands, actions, and liability shall include, without limitations, any injury, damage or loss to person or property which may be (a) caused by any act, or failure to act, by Releasees even if said injury, damage or loss results from the negligence of any or all of the above-identified Releasees or (b) sustained by me during and/or at the Carmel Clay Parks & Recreation program, event, service or facility in which I and/or my child participate(s). Photo and Video Policy Photos and video are periodically taken of participants in a class, during an event, or within Carmel Clay parks and facilities. Photos and video footage are for the use of Carmel Clay Parks & Recreation and may be used in the Department?s publications, website, and social media. All photos are the property of the Carmel/Clay Board of Parks and Recreation.- For more information, please contact the Marketing Director at-317.573.4020 or ilabas@-carmelciayparks.coma-By-signing,this-r-egistration.,fo-r_m.,-I_understand and acknowledge my photo and the other participants listed may be utilized in marketing materials for the Department. Carmel Clay Parks & Recreation reserves the right, at its sole discretion, to withhold and/or withdraw permission to photograph on its premises or to reproduce photographs of objects in its collections. Please follow our photo shoot process and submit the Photo Shoot Application available at http://carmelclayparks.com/policies/. Statement of Accessibility CCPR believes every individual has the right to participate in activities and programs that supports their physical, mental, social and emotional wellness, and therefore contribute to enhancing their overall quality of life. This is achieved by identifying and removing barriers to serve individual and community needs, in addition to providing accessible quality programs and services to all. All requests for modifications must be submitted in writing through our Request for Modifications form available at http://carmelclayparks.com/monon- community-center/mcc-documents/. Please indicate on this form if any modifications are requested for successful inclusion into a program or service in accordance with the Americans with Disabilities Act (ADA). Code of Conduct All users of facilities are expected to exhibit appropriate behavior at all times will participating, spectating or attending any program, event, service and/or facility provided - by Carmel Clay Parks&RecTealioniilis includes inprograr- ents—I. that may or may not require an admission fee, spectating at athletic events, concerts or attending special events.The following guidelines are designed to provide safe and enjoyable facilities for all users. Users shall: Show respect to all users and facility staff/supervisors; Take direction from facility staff/supervisors; Refrain from using abusive or foul language; Refrain from causing bodily harm to self, other users or facility staff/supervisors; Refrain from damaging equipment, supplies and facilities A written or verbal warning shall be given to users/spectators if the Code of Conduct rules have been violated. If there is a second occurrence, users/spectators shall be withdrawn from the facility without a refund. Possible Changes in Listings Carmel Clay Parks & Recreation reserves the right to cancel, combine or divide classes; to change time, date or location of classes; to change instructor assignments; and to make any other changes that may be necessary. We apologize in advance for any inconvenience this may cause. https://anprod.active.com/carmelclayparks/servlet/processReceiptPayment.sdi 3/16/2016 ACCOUNTS PAYABLE VOUCHER CITY OF CARMEL An invoice of bill to be properly itemized must show; kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee Purchase Order No. Gonzales, Steve Terms 1747 Ashton Lane Date Due Mason, MI 48854 Invoice Invoice Description Date Number (or note attached invoice(s) or bill(s)) Amount 3/16/16 200062203 Refund $ 5.00 Total $ 5.00 I hereby certify that the attached invoice(s),or bill(s)is(are)true and correct and I have audited same in accordance With IC 5-11-10-1.6 , 20 Clerk-Treasurer Voucher No. Warrant No. Gonzales, Steve Allowed 20 1747 Ashton Lane Mason, MI 48854 InrSum of$ � I S ON AC, R PO#or INVOIbE NO. ACCT#/TITLE AMOUNT Board Members Deptept# 1096-40 200062203 4358400 $ 5.00 1 hereby certify that the attached invoice(s), or bili(s) is (are)true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except March 23, 2016 IIJJ Signature $ 5.00 Accounts Payable Coordinator Cost distribution ledger classification if Title claim paid motor vehicle highway fund