Free Web Site - Free Web Space and Site Hosting - Web Hosting - Internet Store and Ecommerce Solution Provider - High Speed Internet
Search the Web
  Registration Form
     
Beginner and Intermediate Swing Begins October 3, 2007

Buy Swing DVD's

Latest Girman Pic's as of Sept. 07

Registration Form

Photoalbum

  

Tosa Rec Registration Form

Recreation Department Registration Form

One household only – Please print clearly in ink.

Each adult participant must sign below.  The signature of a parent or legal guardian is required for youth registration.

 

I, the undersigned or parent/guardian of the individual(s) named below, do hereby agree to indemnify and hold harmless the Wauwatosa School District and its employees, officers and agents from and against any and all liability resulting from participation in the activities listed below.  I understand that the program(s) in which I am enrolling, like all activity programs, has some inherent risk, for which I agree to assume the liability.  Furthermore, the individuals named herein are in good physical health appropriate for the activities in which they will be participating.  I understand that the Wauwatosa School District does not provide accident insurance.

 
   
Signature (Participating adult OR parent/guardian of minors listed below Signature (Participating adult #2)
 
Household Information     

Office Use Only

 Total $__________ Date ___________ Initials _________
Name(s) of Head(s) of Household: Email  
Address  City Zip  
Home Phone Work Phone Cell Phone   
        
 Please list more than one choice of a class.  If your first choice is filled, we will try your second choice.  If both are filled, we will contact you.
Program ChoiceClass NameActivity NumberParticipant’s Name (Include First, MI and Last Name)Date of BirthGrade (completed)SchoolFee
1st Choice       
Alternate 

___________--___

  Male       Female
1st Choice    Male       Female    
Alternate 

___________--___

1st Choice 

___________--___

  Male       Female    
Alternate 

___________--___

1st Choice 

___________--___

  Male       Female    
Alternate 

___________--___

1st Choice 

___________--___

  Male       Female    
Alternate 

___________--___

1st Choice 

___________--___

  Male       Female    
Alternate 

___________--___

 If enrolling in Orchestra / Band / Jazz, please list instrument:  __________________________      Special considerations (medical, physical):_______________________________________________________________                                                                                                                                                                                                                                                MasterCard  VISA     ___ ___ ___ ___  ___ ___ ___ ___  ___ ___ ___ ___  ___ ___ ___ ___  exp. Date _____/_____  CW2 ____ ____ ____     Cardholder’s Signature  ________________________________________

 

Fax to:  (414)773-2920   OR   Mail to:  Wauwatosa  Recreation Department    11324 W. Center Street    Wauwatosa, WI  53222   Make all checks payable to Wauwatosa Recreation Department.