Parks and Recreation Registration Form

Purpose: This form is used to register participants for local government-sponsored recreational programs, classes, or events. Please complete all applicable fields to ensure proper enrollment and communication regarding the selected activity.

Participant Information

Full Name: {fullName}

Date of Birth: {dateOfBirth}

Age: {age}

Address: {address}

Phone Number: {phoneNumber}

Email: {email}

Emergency Contact

Emergency Contact Name: {emergencyContactName}

Relationship: {emergencyContactRelationship}

Phone Number: {emergencyContactPhone}

Program Details

Selected Program: {programName}

Location: {location}

Start Date: {startDate}

End Date: {endDate}

Preferred Session Time: {sessionTime}

Medical Information

Allergies or Medical Conditions: {medicalConditions}

{#hasInsurance}

Insurance Provider: {insuranceProvider}

Policy Number: {policyNumber}

{/hasInsurance}

{^hasInsurance}

No insurance coverage provided.

{/hasInsurance}

Additional Participants (e.g., for family programs)

Special Requests or Accommodations

{specialRequests}

Consent & Acknowledgement

{#acknowledgements}

• {statement}

{/acknowledgements}

Parent/Guardian Name (if under 18): {guardianName}

Signature: {signature}

Date: {signatureDate}