Form Center

2. Make all checks payable to “APR ”. Registrations should be dropped off or mailed to:
   Ashland Parks and Recreation
   400 Fourth Avenue W
   Bretting Community Center
   Ashland, WI 54806
4. Family Information
6. Parent/Guardian
7. Date of Birth
   Date of Birth
9. Parent/Guardian
10. Date of Birth
    Date of Birth
12. Address
14. City
15. State
16. Zip Code
18. Phone
19. Cell Phone
21. Child
22. Date of Birth
    Date of Birth
24. Child
25. Date of Birth
    Date of Birth
27. Child
28. Date of Birth
    Date of Birth
30. Child
31. Date of Birth
    Date of Birth
33. Class Participant
34. Class Name
35. Class Number
36. Fee
38. Class Participant
39. Class Name
40. Class Number
41. Fee
43. Class Participant
44. Class Name
45. Class Number
46. Fee
48. Total Enclosed
49. Payment Type

    1. Cash

    1. Check
51. Ashland Parks & Recreation Program Waiver
    I hereby understand that I/or my child(ren) have registered to participate in a program sponsored by Ashland Parks and Recreation. I understand that participating in this activity has some inherent risk and I assume full responsibility for injuries incurred while participating in this program. I represent that I am the parent/guardian of the individual and am fully authorized to enter into the Publicity Release (more information available upon request at the office) on behalf of the registered minor(s).
53. Adult Signature
54. Date
    Date
Leave This Blank:


55. Print Only

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