School Programm Registration Form printable pdf download

Registration Form

Registration continues until courses are ﬁ lled or closed unless otherwise noted

Household/Primary Adult Contact:

q Passholder

q New Address

q New E-mail Address

Last Name: ________________________________________ First Name:___________________________________

Street (no P.O. boxes): _______________________________ City: _____________________ Zip:______________

Primary Phone: __________________________________ Cell Phone:______________________________________

Emergency Phone: _____________________________

*E-mail Address: _________________________________

(*By providing an e-mail address, I agree to allow the TRD to use it to send my receipt and to contact me about my program and

other departmental programs and events. I understand that this information is not shared with outside entities.)

Participant

Activity #

Alternate

Last Name

First Name

Birthdate

M/F

Grade Class Title

and letter

Activity # Fee

Total Fees $

Roster Notes:____________________________________________________________________________

For Youth Leagues ONLY: Please indicate the school your child attends by circling the appropriate letter.

A. Barnard

E. Hill

I. Schroeder

M. Wattles

Q. Boulan

U. Troy High

B. Bemis

F. Leonard

J. Warren Cons.

N. Avondale Schools

R. Larson

W. Private

C. Costello

G. Martell

K. Troy Union

O. Bhm/Blmﬂ d Schools

S. Smith

School/Non-Res

D. Hamilton

H. Morse

L. Wass

P. Baker

T. Athens High

I hereby voluntarily release and hold harmless the City of Troy, City of Troy Contractors/Independent Contractors and the Troy School

District from all liability for all types of damages or injuries, whether foreseeable or not, sustained by myself, my child and other

family members while participating, watching and traveling to or from this activity. I/we also hereby authorize the City to reproduce,

copy, exhibit, publish, broadcast or distribute my image or my child’s image in any and all videotapes and photographs taken while

participating, watching and traveling to or from the activity for promotional purposes.

Signature Required:

Date:

______________________________________________________

_____________

For Mail-In or Drop-Box registrations only-complete the payment box below

Payment (DO NOT SEND CASH) : q Check

Mastercard

VISA

(Payable to City of Troy)

Card Number: ____________________________________________Expiration Date:_______________

Name: _____________________________________Authorizing Signature _______________________

(Please print as it appears on card)

Check here if you need an accommodation and you will be contacted by the ADA Coordinator.

School Programm Registration Form

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