Text Box: NORWAY RECREATION DEPARTMENT PROGRAM/EVENT REGISTRATION FORM Text Box: Family Name: Phone: Address: City: Zip: Emergency Contact: Phone: Relationship: E-Mail Address (optional): Medical Conditions/Medications/Allergies/Etc: Text Box: WAIVER AND RELEASE OF CLAIMS Text Box: PERMISSION SLIP (required for trips only)

I,                                                           , give permission for                                                        to participate in the

 

Norway Recreation Department’s                                                        event on                                                   .

 

Signed:                                               Date:

                                    Parent or Guardian
Text Box: Please drop off or mail registration form to: Norway Recreation Department 6419 Heg Park Road Wind Lake, WI 53185

Recreation Dept. Use Only

Amt Paid

Date

Cash/Chk #

Initials

Name of Participant

Age

Days

Times

Start Date

Program

Fee