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Run: Parks and Recreation Program Registration Form

Use this Parks and Recreation Program Registration Form to collect participant details, guardian consent, emergency contacts, waiver acknowledgements, and pa...

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Program Selection

Program Name (required)

Session Date (required)

Program Location (required)

Participant Type (required)

Program Format (required)

Participant Information

Participant First Name (required)

Participant Last Name (required)

Participant Date of Birth

Only collect if age verification is needed for this program.

Age Group (required)

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 (required)

Relationship to Participant (required)

Guardian Email (required)

Guardian Phone (required)

I confirm I am authorized to register this minor and consent to participation. (required)

Yes No N/A

I consent to photos or video being used for program communications or promotional materials.

Yes No N/A

Emergency Contact Information

Emergency Contact Name (required)

Relationship to Participant (required)

Emergency Contact Phone (required)

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? (required)

Activity Restriction Details

Does the participant need a reasonable accommodation? (required)

Accommodation Request Details

Fees, Waivers, and Certification

Registration Fee

Enter the amount due if applicable.

Payment Status (required)

I have read and agree to the participation waiver and liability release. (required)

Yes No N/A

I agree to follow the program code of conduct and safety rules. (required)

Yes No N/A

I consent to be contacted about registration updates, schedule changes, and program notices. (required)

Yes No N/A

Signature (required)

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.

Get your results

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Email (required)

Your name (optional)

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