Spring 2017 SWIM Registration Form

Spring 2017 PROGRAM Registration Form

Spring 2017 SWIM Registration Form

______________________________________________________________________________________________________________________________________________ FAMILY LAST NAME ( Child name if different than parent ) HOME PHONE WORK PHONE

______________________________________________________________________________________________________________________________________________ m Mr . m Mrs . m Ms . ADDRESS ZIP CODE

Swimming , Activity & Season Pass Registrations ( Please list a 2nd choice for all swimming registrations .)

FIRST NAME AGE POOL LEVEL DAY TIME FEE

______________________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________

Please sign waiver on back

______________________________________________________________________________________________________________________________________________

ATTENTION : Please list any medication ( s ) your child is currently taking or needs to be administered during our programs . Please list any health or behavior related conditions for which your child is being treated .

[ ] [ ] illcreek MILLCREEK TOWNSHIP - RECREATION & PARKS

______________________________________________________________________________________________________________________________________________ NAME

MEDICATIONS / CONDITION

Spring 2017 PROGRAM Registration Form

Please use this form for all other activities other than swimming .

______________________________________________________________________________________________________________________________________________

[ ]

FAMILY LAST NAME ( Child name if different than parent ) HOME PHONE WORK PHONE

______________________________________________________________________________________________________________________________________________ m Mr . m Mrs . m Ms . ADDRESS ZIP CODE

FIRST NAME AGE ACTIVITY DAY TIME FEE

Please sign waiver on back

______________________________________________________________________________________________________________________________________________ NAME

MEDICATIONS / CONDITION

Please make checks payable to : Millcreek Township Supervisors / Please sign waiver on back

Please mail registration and signed waiver to : Millcreek Recreation and

Parks Department , Millcreek Municipal Building , 3608 West 26th St .,

Erie , PA 16506

I ( we ) agree to the regulations for operation of the facilities ; understand that the use of the pools and gyms are at the risk of the participant .

** All checks returned to us after deposit will be assessed an non-sufficient funds ( NSF ) fee .

Millcreek | Spring 2017 | icmags . com 19

IN Millcreek Spring 2017 | Page 21

Spring 2017 SWIM Registration Form

Spring 2017 PROGRAM Registration Form

Spring 2017 SWIM Registration Form

Please sign waiver on back

[ ] [ ] illcreek MILLCREEK TOWNSHIP - RECREATION & PARKS

Spring 2017 PROGRAM Registration Form

Please sign waiver on back