Household Enrollment Form Prairie View Community Center, 6834 Dempster St, Morton Grove, IL 60053 Phone: (847)965-1200 Fax: (847)965-4115 mortongroveparks.com
The Morton Grove Park District is transitioning to a new registration system. Help us help you in creating your NEW Household Account. COMPLETE this form and summit it to Prairie View Community Center. PLEASE NOTE: All current households will be transferred to the new system BUT all households will need to show proof of residency.
PRIMARY GUARDIAN FIRST AND LAST NAME ____________________________________________________________________________________ ADDRESS ____________________________________________
CITY ____________________________
ZIP __________________
PRIMARY PHONE ______________________________________
OTHER PHONE ____________________________________________
EMAIL ADDRESS _____________________________________________________________________________________ BIRTH DATE ___________ SECONDARY GUARDIAN FIRST AND LAST NAME ________________________________________________________________________________ ADDRESS ____________________________________________
CITY ____________________________
ZIP __________________
PRIMARY PHONE ______________________________________
OTHER PHONE ____________________________________________
EMAIL ADDRESS _____________________________________________________________________________________ BIRTH DATE ___________ ADDITIONAL FAMILY MEMBERS (FIRST AND LAST NAME)
SCHOOL
BIRTH DATE
GENDER M F M F M F M F M F M F M F
RESIDENCY VERIFIED â–¡
STAFF INITIALS __________
register at mortongroveparks.com | 2016-17 Winter Spring Activity Guide
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