Summer 2016 SWIM Registration Form

Summer 2016 PROGRAM Registration Form

Summer 2016 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

Summer 2016 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 LOCATION 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

In applying to the Pool Season Passes listed on the following pages, 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; and further acknowledge that passes may not be loaned and are limited to my( our) immediate family; the permit and those privileges associated with it are not transferable and will be lifted if presented at the entrance by anyone else.

Millcreek | Summer 2016 | icmags. com 19

IN Millcreek Summer 2016 | Page 21

Summer 2016 SWIM Registration Form

Summer 2016 PROGRAM Registration Form

Summer 2016 SWIM Registration Form

Please sign waiver on back

[ ] [ ] illcreek MILLCREEK TOWNSHIP- RECREATION & PARKS

Summer 2016 PROGRAM Registration Form

Please sign waiver on back