Recreation Brochure - Town of Amherst

Mail-in registration begins immediately
Registration may be dropped off by Wednesday for the following week or before the start of new session
Registration is on a first come, first served basis
A Valid Resident ID card number must be provided on all registration forms or they will not be accepted.
Incomplete forms will be returned
Please make sure that all registration forms are filled out completely, accurately and legibly.
You may register participant/s for all programs on one form - use more is additional space is needed
Registration fee is non-refundable.
Make checks payable to the Town of Amherst Youth & Recreation Department
Registration forms must be mailed in to:
Town of Amherst Youth & Recreation Department
1615 Amherst Manor Drive
Williamsville, NY 14221
Please provide your e-mail address or enclosed a self-addressed stamped envelope for confirmation reply.
Participant’s Name
Registration Information
PROGRAM REGISTRATION Youth & Recreation Department 2013
PLEASE PRINT ALL INFORMATION
Indicate class/time preference
Head of Household
Date of Birth Gender: M F
Address
E-Mail address
Primary Phone Secondary Phone
ID
Number
Date of Birth Activity/ Program Level Location Session # Class Time Fee
Check or Money Order Only Total Fee:
I, the undersigned certify that my child/children have permission to participate in the recreation programs of the Town of Amherst, New York
Remarks: Please list any physical limitations, allergies, asthma, seizures, medications, injuries or diseases past or present, which the
instructor should be aware of while caring for your child.
I hereby authorize the Amherst Youth & Recreation Department to use participant’s photographs, videos and audio recordings or other likeness
taken for reproduction in advertising display or editorial use.
Signature of parent or guardian Date
20 www.amherst.ny.us