2014-15 Fall

36
Registration Form
Registration Form
ADULT or RESPONSIBLE PARTY INFORMATION
(Please fill in the information below – if you are registering more than 2 people, photocopy this form as needed)
Last Name First Name MI Date of Birth
Mo/Day/Yr
Mailing Address
Resident
City State Zip Code
Non-Resident
( ) — ( ) —
Phone number
Emergency Number
Email Address:
PARTICIPANT #1 INFORMATION
(Please fill in the information below – if you are registering more than 2 people, photocopy this form as needed)
School Grade
in Fall of 2014
Last Name First Name MI Date of Birth Mo/Day/Yr
PARTICIPANT #2 INFORMATION
(Please fill in the information below – if you are registering more than 2 people, photocopy this form as needed)
School Grade
in Fall of 2014
Last Name First Name MI Date of Birth Mo/Day/Yr
Will you coach
Participant Name
Program Name
this team? Y or N Program Fee
CONSIDER YOURSELF ENROLLED Sid Sample – WE DO NOT Youth SEND Soccer CONFIRMATIONS
League - Mites Yes $45.00
No refunds given after activity begins. All persons
participating in Parks and Recreation Department
programs do so at their own risk and without recourse
to the Town of York, its agents, officers or employees.
Make Checks Payable to:
York Parks & Recreation Department
Mail Registration Form to:
York Parks and Recreation Department
186 York Street
York, ME 03909
_____________________________
Signature of Parent/Guardian or Responsible Party
TOTAL $
Your Check #
York Parks and Recreation Department I 363-1040