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Child's Name *

Age *

Years in Program

Grade *

School

Date of Birth *

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Parent/Guardian Name *

Street Address *

City *

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Phone *

xxx-xxx-xxxx

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Shirt Size *

IMPORTANT INFORMATION PLEASE READ!

Comments or Medical Information

Picture Release *

Yes I, as a participant or legal guardian representing a minor participant agree to allow BCPR to use pictures taken at events for promotional purposes

No I, as a participant or legal guardian representing a minor participant do not agree to allow BCPR to use pictures taken at events for promotional purposes

Price

Signature (Type Name Here) *

By typing your name here you agree for your child to participate in Brown County Parks and Recreation activities.

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