Registration Information One child to a form. More forms are available at the Lakes Area Recreation office or you may duplicate the form. Fee must accompany registration. Make checks payable to: Lakes Area Recreation. Mail to: 720 Fillmore St., Suite B020 • Alexandria, MN 56308. Phone in registration with Master Card or Visa, or register with ActiveNet on-line registration at www.lakesarearecreation.com. Reimbursement Policy (A credit will be issued for future LAR activities): There will be a $2 “Transaction Fee” for all refunds and transfers to other activities. A credit (less a $2 “Transaction Fee”) will be issued if a participant calls prior to the start of the activity. No credits will be issued after the starting date of the activity. Special Needs: If you have a disability and assistance is needed in participating in any Lakes Area Recreation class, or if you have questions about accessibility, call 762-2868. United Way of Douglas & Pope Counties has made fee assistance available. In order to qualify for fee assistance you must bring a copy of your qualification for free or reduced lunch from School District 206 and/or proof of assistance from Social Services, and register for all activities in the LAR office. Fitness classes, dance and camps do not qualify for United Way Funding. Call 762-2868 if you have any additional questions. Rainbow Rider bus service is available to provide transportation for Lakes Area Recreation activities. For more information please call 1-800-450-7770.
Lakes Area Recreation Fall/Winter 2012/2013 720 Fillmore Street, Suite B020 • Alexandria, MN 56308 • (320) 762-2868 Name
Phone_H ________________ First Name
MI
Last Name
Address
Phone_W ________________
Parent’s Name __________________________________________________Cell Phone _______________ E-Mail Address_________________________________ Please check box if willing to volunteer with programs: Indicate Residency: City
Township
Grade ('12-'13) _____
Birth Date __________________ Age _____________ Gender M/F ____ Shirt Size _________ Activity Name
Level
Class #
I, the undersigned, give permission to the above named child, over whom I have legal supervision, to participate in this Lakes Area Recreation activity. I do not hold Lakes Area Recreation, Douglas County, or School District #206 responsible for any personal injury or damage or loss to property while participating in this program.
Signature of Parent/ Guardian
26
Date
Time
Fee
FOR RECREATION OFFICE USE ONLY Date Received: _________________ By: _________ p Ck#: _____________ Amt: ____________ CREDIT CARD INFORMATION Visa MasterCard Exp. Date: ______ Credit Card # (include all numbers)
Date Office: (320) 762-2868 • Hotline: (320) 762-3010 www.lakesarearecreation.com