Registration Form New Berlin Parks, Recreation & Forestry Department Registration Form Family members from the same household may complete one form
LAST NAME ___________________________________________
HOME PHONE __________________________________
ADDRESS _____________________________________________
DAY PHONE ____________________________________
CITY _________________________________________________
ZIP ___________________________________________
SIGNATURE ___________________________________________
E-MAIL ADDRESS _______________________________
I have read the registration policies in this booklet Signature (Participant if over 18 or parent/guardian)
We will not share your e-mail with any other group or organization
You will be placed on a waiting list if your choices are filled
Participant’s First Name
Class Choice
Class #
Program Title
Level
Day(s)
Starting Starting Date Time
Fee
Gender
Age
Grade
Birth Date (if under 18)
1st Choice 2nd Choice 3rd Choice
1st Choice 2nd Choice 3rd choice
1st Choice 2nd Choice 3rd Choice
Total Program Fees:
$ _______________
Total Non-Resident Fees:
$ _______________
Round up Donation Program:
$ _______________ (See page 44 for further information)
Total Amount:
$ _______________
Please send FAX registrations only one time. Please do not staple checks to registration form.
Enclose one check for the total amount payable to: New Berlin Parks, Recreation & Forestry Department. Credit Card Information (Please print clearly) ❑ MasterCard ❑ Visa card Exp. Date ____ / ____
Card # _________________________________
_______________________________________ Card Holder Name (Please Print)
MAIL or FAX to: New Berlin Parks, Recreation & Forestry Department P.O. Box 510921 • New Berlin, WI 53151 Phone (262) 797-2443 • Fax (262) 797-2460
www.newberlin.org
Signature X __________________________________________________ If you have any special needs.disabilities, please indicate it on your registration.
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