SPRING 2018 SWIM Registration Form
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FAMILY LAST NAME (Child name if different than parent)
HOME PHONE
WORK PHONE
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m Mr.
m Mrs.
m Ms.
ADDRESS
ZIP CODE
Swimming, Activity & Season Pass Registrations (Please list a 2nd choice for all swimming registrations.)
FIRST NAME
AGE
LEVEL
DAY
TIME
FEE
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le child is currently taking or needs to be administered during our programs. Please list any health or
ATTENTION: Please list any medication(s)
P your
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behavior related conditions for which your child is being treated.
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NAME MEDICATIONS/CONDITION
SPRING 2018 PROGRAM Registration Form
Please use this form for all other activities other than swimming.
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FAMILY LAST NAME (Child name if different than parent)
[ HOME ] PHONE
[ WORK ] PHONE
______________________________________________________________________________________________________________________________________________
m Mr.
m Mrs.
FIRST NAME
m Ms.
ADDRESS
AGE
ACTIVITY
DAY
ZIP CODE
TIME
FEE
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on
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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 Recreatio n and Parks Department,
Millcreek Municipal Building,
3608 West 26th St., Erie PA 16506
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. All checks returned to us after deposit will be assessed a non-sufficient
funds (NSF) fee.
MILLCREEK
❘
SPRING 2018
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