Summer 2024 SWIM Registration Form
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Please sign waiver on back
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FAMILY LAST NAME ( Child name if different than parent ) HOME PHONE CELL PHONE
______________________________________________________________________________________________________________________________________________ m Mr . m Mrs . m Ms . ADDRESS ZIP CODE
Swimming , Activity & Season Pass Registrations
Please list a 2nd choice for all swimming registrations .
[ You will only be notified if your 2nd choice is selected . ]
FIRST NAME AGE POOL SESSION LEVEL TIME FEE
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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 .
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MEDICATIONS / CONDITION illcreek
MILLCREEK TOWNSHIP - RECREATION & PARKS
Summer 2024 PROGRAM Registration Form
Please use this form for all other activities other than swimming .
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FAMILY LAST NAME ( Child name if different than parent ) HOME PHONE CELL PHONE
______________________________________________________________________________________________________________________________________________ m Mr . m Mrs . m Ms . ADDRESS ZIP CODE
FIRST NAME AGE ACTIVITY LOCATION DAY TIME FEE ______________________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________
Please sign waiver on back
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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 .
______________________________________________________________________________________________________________________________________________ NAME
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
MEDICATIONS / CONDITION
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 . ** All checks returned to us after deposit will be assessed a non-sufficient funds ( NSF ) fee .
MILLCREEK ❘ SUMMER 2024 29 4