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Spring 2017 Registration Form( Page 2)
Please Print Participant’ s Name: ________________________________________________
REGISTRATION INFORMATION CONTINUED Program Information
Transportation Information
Program Code Fee Code Fee Pick Up Site Drop Off Site
SUBTOTAL
( Program & Transportation Fees)
SUBTOTAL: Please carry this subtotal over to front of form.
COMMENTS: 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: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________
If you would like to discuss your comments with an NSSRA staff member, please check the appropriate box: Yes No
REGISTRATION DEADLINE: FRIDAY, FEBRUARY 24 @ 5:00 PM
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Register online at register. nssra. org.