Summer 2017 Registration Form
(Page 2)
Please Print Participant’s Name: ________________________________________________
REGISTRATION INFORMATION CONTINUED
Program Information
Program
Code
Transportation Information
Fee
Code
Fee
Pick Up Site
SUBTOTAL
Drop Off Site
(Program &
Transportation Fees)
SUBTOTAL:
Please carry this subtotal over to front of form.
Register Additional Family Members and Friends for Summer Bash:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
COMMENTS: We Welcome Your Input
Thank you for participating in programs with NSSRA and/or your
local park district or recreation department. NSSRA services include
providing year-round recreation programs for the residents of
its 13 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, MAY 19 @ 5:00 PM
58
Register online at register.nssra.org.