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