Barrington Registration Form

(PLEASE PRINT)

VISA/MASTERCARD CHARGE ($25.00 minimum)

CASH $_____________________ CHECK #____________________

1. VISA MASTERCARD

FAMILY NAME_________________________________________________________

2. Card Number____________________

ADRRESS______________________________________________________________

3. Expiration Date on Card____________________

CITY & ZIP CODE______________________________________________________

4. Amount of payment____________________

Phone No. Home_________________________Work___________________________

5. Authorized Signature____________________

Please Ceck:

In District

Out-of-District

Out of District/Member

Registration Notice - Register Early!
All participants should register no later than 48 hours prior to the start date of the program. Any programs that have not met the minimum registration requirement within 48 hours of the start date will be cancelled. Some programs may require proof of age. Birth certificates may be requested.

Questions? ADA - Does the participant require accomodations or assistance? yes no

Call 381-0687 Please indicate second choice program with a " " immediately following your first choice line

If your first choice is filled, you will be placed in your 2nd choice program.