Scribd
Upload
39 views2 pages

Program Registration Forms

This document is a registration form for recreational activities. It collects contact information like name, address, phone numbers, and emergency contacts. It asks the registrant to select one activity from a list of options like aerobics, dance, martial arts, and art classes. The registrant must sign acknowledging they consulted a physician and the city is not liable for any accidents during participation.

Uploaded by

mprecreation
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as RTF, PDF, TXT or read online on Scribd
Download as rtf, pdf, or txt
39 views2 pages

Program Registration Forms

This document is a registration form for recreational activities. It collects contact information like name, address, phone numbers, and emergency contacts. It asks the registrant to select one activity from a list of options like aerobics, dance, martial arts, and art classes. The registrant must sign acknowledging they consulted a physician and the city is not liable for any accidents during participation.

Uploaded by

mprecreation
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as RTF, PDF, TXT or read online on Scribd
Download as rtf, pdf, or txt
Download as rtf, pdf, or txt
You are on page 1/ 2

Program Registration

Form
Date:____________________________

Name:______________________________________________________________________
__

Address:____________________________________________________________________
___

City:_______________________________ State:_________ Zip Code:


___________________

Phone:________________________________ Cell:
___________________________________

Please List 2 people we should call in case of an emergency

Name:___________________________________
Phone:_______________________________

Name:___________________________________
Phone:_______________________________

Please select an activity (CHECK ONE)

Adult Aerobics ($20) _____ Senior Aerobics ($10) _____


Judo ($80) _____

Evening Aerobics ($25) _____ Line Dance ($20) _____


Cheer/Dance ($20) _____

Ball Room Dance ($30) _____ Karate ($25) _____


Drum Line ($25) _____

Floral Design ($20) _____ Adult Art ($20) _____ Art


With Heart _____
Tumbling ($20) _____

You are expected to consult with your physician before participating in any of
the classes. The City of Moss Point or its affiliates are not liable for any
accidents or incidents that may occur during or after your participation in
any classes.

Signature: _____________________________________________ Date:


__________________

You might also like