Portland Parks & Recreation
Register Now - One of Five Ways •On-line at www.PortlandParks.org Hover over the Recreation tab and click on Class Search/ Registration. Search for classes by age category, by keyword, or narrow your search by specific activity. •PHONE - Complete this registration form and call any PP&R site using the phone numbers the previous map pages. You may also phone in your registration to the Park’s Customer Service Hotline at 503-823-2525, Monday through Friday, 8:30am to 4:45pm. Phone in registration is accepted with Visa or Mastercard only. •MAIL - Mail in your completed registration form to the program center address. Include full payment using your Visa, Mastercard or check payable to the City of Portland. Mail-in registration is also accepted at the Park’s Customer Service Center, 1120 SW Fifth Ave. Suite 1302, Portland, 97204. •FAX - Complete the registration form and fax it to the program center fax number with full payment using your Visa or Mastercard. Faxes are accepted 24 hours a day, seven days a week, but are processed during regular business hours. •IN PERSON - Any PP&R facility is able to process your registration, including the Customer Service Center located on the first floor of the Portland Building at 1120 SW 5th Ave. All Community Centers are open for walk-in registration during business hours. CHECK ONE:
New Customer Taken class with PP&R before My Account information has changed
Home Address___________________________________________________ City/ST/Zip____________________________ Home Phone (_____)_________________________________ Work Phone (_____)_________________________________ Cell Phone (_____)_____________________________ Email Address: ____________________________________________ Emergency Contact Name & Phone Number ________________________________________________________________ Portland Parks & Recreation welcomes individuals with disabilities and special needs into programs. Please describe any accommodations needed for successful inclusion:_____________________________________________________________ PARTICIPANT INFORMATION Birthdate
M/F Class Title
Course # Class Location
Non-Residents of the City of Portland pay a 30% surcharge. Or you may purchase a non-resident pass at the amounts listed below. List pass price or 30% surcharge in column at right and add to your total. I already have a NR card. Kind of card___________________ Purchase date ___/___/___ Passholder name ____________________________________________________________ I need a card. Circle one: 3 mo. / 6 mo. / 9 mo. / 1 yr. Circle one: Individual / Family Name of person(s) needing card________________________________________________ I do not want a card. I choose to pay the 30% surcharge.
f o rm
Name (last, first)
Start Date Cost
Subtotal 30% non-resident surcharge or Card Total
PAYMENT INFORMATION
CHECK
Check number___________________ Make checks payable to the City of Portland.
CREDIT CARD Information: Account # ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___ Expires __________________ Cardholder’s Name________________________________________ Please print
VISA Mastercard
Signature__________________________________________________ Register On-Line at www.PortlandParks.org
reg i strat i o n
Main Contact Name___________________________________________ Birthdate_______________ Male___ Female___
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