Parks and Recreation Program Registration Form

Registration form for a parks and recreation program that collects participant details, emergency contacts, waiver acknowledgements, and fee/payment information.

Program Selection

• Program Name
• Session Date
• Program Location
• Participant Type
• Program Format

Participant Information

• Participant First Name
• Participant Last Name
• Participant Date of Birth
  Only collect if age verification is needed for this program.
• Age Group
• Gender
  Optional. Collect only if needed for program administration or grouping.
• Medical or Accessibility Notes
  Provide only information needed for safe participation or reasonable accommodation. Do not include full medical records.

Parent or Guardian Consent

• Guardian Full Name
• Relationship to Participant
• Guardian Email
• Guardian Phone
• I confirm I am authorized to register this minor and consent to participation.
• I consent to photos or video being used for program communications or promotional materials.

Emergency Contact Information

• Emergency Contact Name
• Relationship to Participant
• Emergency Contact Phone
• Secondary Emergency Contact Name
• Secondary Emergency Contact Phone
• Authorized Pickup Names
  List only if the program requires pickup authorization.

Health, Safety, and Accommodation

• Allergies or Medications Relevant to Participation
  Include only information needed for safety planning. Do not enter full medical histories.
• Are there any activity restrictions we should know about?
• Activity Restriction Details
• Does the participant need a reasonable accommodation?
• Accommodation Request Details

Fees, Waivers, and Certification

• Registration Fee
  Enter the amount due if applicable.
• Payment Status
• I have read and agree to the participation waiver and liability release.
• I agree to follow the program code of conduct and safety rules.
• I consent to be contacted about registration updates, schedule changes, and program notices.
• Signature
• What happens after I submit
  Your registration will be reviewed for completeness. If payment, waiver, or additional information is needed, the program team will contact you. Keep a copy of your confirmation for your records.