309891 4/4/17-VOIDED ag CITY OF CARMEL, INDIANA VENDOR: 371599
ONE CIVIC SQUARE P
CHECK AMOUNT: $**...***33.00*
o o BO 4 9880 CHECK NUMBER: 309891
9M CARMEL, INDIANA 46032 INDIANAPOLIS IN 46280 CHECK DATE: 04/04/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1096 4358400 2001761003 33.00 REFUNDS AWARDS & INDE
<
CO 2 / O k
/ - q f /
E a % / � O /
3. \ o z O AOo
� 2 < E 0) 22
k % / w k o
\
C4 =r
p #
/ \ / k 2 « 00
m i > $ q
Co
0 0 2 & F
J § k \ q k
/ ® ;u \
/ \ \ Z
CL \ ¥ > 3 P
2
w w \
CD 2 R a
» ] R
nm — m
f \ ƒ a ƒ $
& & M z a E
2 - / ° Q J
> g q � a +
o - « n 2
k ƒ ] (D E
@ E / CL 9
CD
2 S % \ S
/ / \ / 0 /
= 2 & - M / a
CD ® � / E % 9
/ / § _/ k § h
\ J ƒ C |
/ F
o 0
Recei ,1#2001761.003 •"' x
F .... .. ......... .. ... S Page 1 of 3
GVW
f, u
Monon CommunityCenter East oucher #2001761.003
Building Mar 28, 2017 1:09 PM
1235 Central Park Dr. East
Carmel, IN 46032
Phone: (317) 848-7275
FAX: -- Car el
Email: info@carmelclayparks.com
Parks&Recreation
NATIONAL GOLD MEDAL WINNER
JOHN
55 EASTT 111TH ST. AND ACCREDITED ADEN _
1
P. 0. BOX 40980 R '
INDIANAPOLIS, IN 46280
Prepared By: amandaj MAR 2 9 2017
Customer ID: 27712 I
s
Primary phone: (765) 623-9810, Secon ary p onTi e:-- y
Refund Summary _
Check: ($33.00) Check #
Total Received: ($33.00) Total Refund: ($33.00)
Transactions
Customer Description Item Unit Qty Fee Charge
)ohn Cron Coed Volleyball League: Recreational #377002-01 Activity Fee Each 1.00 $330.00 ($330.00)
55 East 111th St, Action: Adjust for Modification
P.O.Box 40980 Early Each 1.00 10.00% $33.00
Indianapolis,IN 46280 Meets: From January 30, 2017 to April 24, 2017 Registration
Primary phone:(765)623- Each Monday from 8:15pm to 10pm Discount
9810 Location:
Email: Gymnasium C at Monon Community Center West Building
John.Cron@deltafaucet.com
ID:27712
Sohn Cron Coed Volleyball League: Recreational #377002-01 Activity Each 1.00 $264.00 $264.00
55 East 111th St. Action: Modification Fee
P.O.Box 40980
Indianapolis,IN 46280 Meets: From January 30, 2017 to April 24, 2017
Primary phone:(765)623- Each Monday from 8:15pm to 10pm
9810 Location:
Email: Gymnasium C at Monon Community Center West Building
John.Cron@deltafaucet.com
ID:27712
Total Charges ($33.00)
Total Payments ($33.00)
Balance $0
Activity Waiver
Waiver for:John Cron
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
https-.//anprod.active.com/carmelclayparks/servlet/processReceiptPayment.sdi 3/28/2017