Summer 2024 SWIM Registration Form
______________________________________________________________________________________________________________________________________________ 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
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Please sign waiver on back
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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
______________________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________
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
MEDICATIONS / CONDITION illcreek
MILLCREEK TOWNSHIP- RECREATION & PARKS
Summer 2024 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 CELL PHONE
[ ]
[ ]
______________________________________________________________________________________________________________________________________________ m Mr. m Mrs. m Ms. ADDRESS ZIP CODE
FIRST NAME AGE ACTIVITY LOCATION 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.
______________________________________________________________________________________________________________________________________________ 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. ** All checks returned to us after deposit will be assessed a non-sufficient funds( NSF) fee.
MILLCREEK ❘ SUMMER 2025 41 4