2016 Fall Registration Form (Page 2)
PLEASE PRINT PARTICIPANT’S NAME ON THIS SIDE:
NAME: __________________________________________________________
PROGRAM INFORMATION
PROGRAM NAME
CODE
TRANSPORTATION INFORMATION
FEE
CODE
FEE
PICK UP SITE
PLEASE CARRY THIS SUBTOTAL OVER TO FRONT OF FORM
DROP OFF SITE
SUBTOTAL
PROGRAM &
TRANSPORT FEES
SUBTOTAL:
Register Additional Family Members and Friends for Cultural Arts Open House Here:
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VALUE CHECK FORM/COMMENT SHEET - WE WELCOME YOUR INPUT
You or your child is participating in programs through NSSRA
and/or your local park district or recreation department. NSSRA
services include providing year-round recreation programs for
the residents of its thirteen partner communities, inclusion
support, sign language interpreters, behavior management
support and training, disability awareness training and any other
services necessary to involve you and your child in community
recreational activities.
We encourage you to share with us your thoughts and ideas
about our current services or other services which you would like
to see us offer. We use your comments to develop new programs,
train support staff and companions, and improve the quality of
NSSRA and park district or recreation department programs.
We value your feedback!
We invite you to share with us your program ideas and comments about our services:
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IF YOU WOULD LIKE TO DISCUSS YOUR COMMENTS WITH A NSSRA STAFF MEMBER, PLEASE CHECK THE APPROPRIATE BOX.
YES
NO
REGISTRATION DEADLINE: FRIDAY, AUGUST 12 @ 5:00 PM
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Register online at register.nssra.org.