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Play Inside the Triangle NEW Customer

Returning Customer (skip to Activity Registration Section)

Check here to receive promotional emails and class notifications

Adult/Parent/Guardian Last Name

Adult/Parent/Guardian First Name

Birthdate

Street Address (New customer only)

City

Zip

Alternate/Emergency Phone (

)

Contact Phone (

)

Current E-mail Address

Activity Registration Participant(s) Last Name

First Name

Male/ Female

Birthdate

Name of Activity

Class #

Fee

TOTAL To assure our programs benefit all who at tend, please check here if any par ticipant has special needs requiring special accommodations.

I hereby agree to indemnify and hold harmless the City of Tracy, its officers and employees, and any community organization co-sponsoring the program from and against any and all liability for any injury which may be suffered by me or my child, arising out of or in any way connected with participation in the program named above. My signature below indicates that I am aware of and understand how this program will be conducted. I understand that a refund/credit will not be issued unless requested no later than 5 business days prior to the first day of an activity. I understand that unless otherwise notified, the City of Tracy reserves the right to utilize photos and/or quotes of program participants for the specific purpose of promoting their programs and facilities. Signature Required: Payment Type: Charge to my: (

Credit

Date: Cash

) MasterCard

Check (made payable to the City of Tracy)

(

) VISA

(

) AMEX

(

Other

) Discover

Card No. Expiration Date:_____/_____

CCV:

Cardholder’s Authorized Signature:

Mail-In

Mail your registration form and payment information to: Grand Theatre Center for the Arts Attn: Program Registration 715 N Central Ave Tracy, CA 95376

Walk-In

Walk-in registrations accepted at: Grand Theatre Center for the Arts, Leona Darr Willis Box Office 715 Central Avenue, Monday-Thursday 8am to 6pm, and every other Friday, 8am to 5pm. Excluding holidays.

Online

Create account and register online at www.tracyartsandrec.com

Fax

Fax your completed registration form with valid credit card information to (209) 831-6218 or (209) 831-6271.

Register online at www.tracyartsandrec.com • (209)831-6202

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City of Tracy Registration Form  
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