Registration Form
REGISTRATION FORM
Parks and Recreation Services
1850 Soscol Ave. Suite 201, Napa, CA 94559
707-257-9529
www.cityofnapa.org
Primary Adult Name:
Birth Date:
Address: City:
Email: City of Napa Resident: Yes No
Primary Phone: Secondary Phone:
Emergency Contact: Relationship:
Primary Phone: Secondary Phone:
Activity #
Activity Name
State:
Participant / Child Name
Zip:
Birth Date
Fee
Donate to Napa Youth Scholarship Fund: Yes No
OFFICE USE ONLY:
*Special Accommodations:
Non-resident Fee:
Total Fees:
City of Napa welcomes all individuals into our programs. Please describe any accommodations needed
(e.g. allergies, physical accommodations, medical conditions, medications, etc.).
The undersigned in consideration of participation in this program agrees to indemnify and hold the City of
Napa harmless, and release the City of Napa from any and all liability claims, and necessary costs and
expenses for any loss/damage to property or injury from any cause whatsoever regardless of negligence,
which may be suffered by the above-named individual registered in this program, arising out of, or in any
way connected with participation in this program and/or use of the premises. I understand that photographs
taken of recreation programs may be used by the Parks & Recreation Services Department for promoting
our programs, classes or events.
______________________________________________
Signature
Participant Parent Guardian
____________________________________
Date
OFFICE USE ONLY: Receipt #: ______________ Type of Payment: Cash Check Credit Card
[Type here]
Comments: __________________________________________________________________________________
Check us out online at www.cityofnapa.org/parksandrec