Fillable Registration Form printable pdf download

REGISTRATION FORM

• Please write legibly; fill in all required spaces; indicate the activity number for each class

• Mail or bring your registration form to: Recreation Center, 650 Shell Blvd. Foster City, CA 94404

or Fax it to: 650-345-1408

• You will receive a confirmation of registration in the mail

ContaCt information

Name: ___________________________________________________________________________________

Street Address: ____________________________________________________________________________

City: ________________________ Zip: ______________ Email: _____________________________________

Home Phone: _______________________________ Work Phone:___________________________________

aCtivity registration

Participant’s Name

Age Date of Birth Activity Name

Day/Time Activity #

Fee

Fees: $_______

Persons with disabilities are welcome to participate in any

class or activity offered. Do you have any special needs that

Non-Resident Fee (add $10 per class): $_______

require specific accommodations so you can fully enjoy one of

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our classes or facilities? If yes, check here:

TOTAL: $_______

Payment information

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Payment Method:

Cash

Check (Payable to “City of Foster City”)

Credit Card

I hereby authorize the use of my Mastercard or Visa account.

Name on Card: _________________________________________________

Card Number: __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __

Expiration (Month/Year): _______ /_______ 3-Digit Security Code: ______

Signature: _____________________________________________________

LiabiLity waiver & Photo reLease

I hereby agree to hold the City of Foster City, the Estero Municipal Improvement District, their employees, officers, and program and activity

instructors harmless from all liability which may arise as a result of my participation in the above activities. In the event that the above

named participant is a minor I hereby give my permission for his/her participation in the above listed activities and also agree to hold the

City of Foster City, the Estero Municipal Improvement District, their employees, officers, and program and activity instructors harmless from

all liability which may arise as a result from said minor’s participation in such activities. I understand that the above named activities may

involve risk or accidental injury and hereby voluntarily assume such risks. I/we agree to allow my/our photo for program publicity. If the

participant is a minor, the parent or guardian must sign below.

Signature: _____________________________________________ Date: ______________________________

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Participant

Parent

Guardian

Registration Form

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