To register:

Please send check and signed registration form to East Norriton Township Parks and Recreation Dept., 2501 Stanbridge St., East Norriton, PA 19401.  Please make checks payable to East Norriton Township. For additional registration information call 610 275-2800 and push 4 on your telephone key pad for Parks and Recreation.

PROGRAM/TRIP REGISTRATION FORM

(please submit with payment)

(this form is not for youth sports leagues, ENGAA or ENLL reg.  please call the Rec. Office for proper forms for youth sports). 

Name _______________________________________________________________________________________

Address______________________________________________________________________________________

Phone number __________________________________Business phone _________________________________

Activity ____________________________________________________________________________________

Registration fee ___________________Total amt. enclosed______________________

Please check one________Adult (l8 yrs. old and over)        _____________ Youth (please include age) _______

      I assume all risks in connection with this activity sponsored by the East Norriton Township Parks and Recreation Department and hereby release, absolve, indemnify, and hold harmless the Township of East Norriton, the Department of Parks and Recreation, the Director of Parks and Recreation, all sponsors, organizers, and trip leaders appointed by them of all liability by reason of any damage or injury to any person or thing in connection with this activity.

Signature___________________________________________Date_______________

                 (if under l8 parents or guardian sign)

*TRIPS‑ Deposit or full payment is due when reserving space on trips.  Spaces will be held only one week without payment.

.

**REFUNDS:  Subject to a $5.00 administrative fee and must be requested prior to start of class or program.  For trips or special events, refunds will be given only if a replacement can be found.

***CANCELLATIONS: ‑ The parks and recreation department reserves the right to cancel any program, trip or special event.  Full refunds will be given in the event of a cancellation.                 

****HANDICAP INFO: ‑ Persons with a handicap or require special needs who wish to participate in any of our recreational offerings should contact the Director of Parks and Recreation at 610 275-2800, ext. 120.

*****PICTURE RELEASE: The above signed individual also gives permission to the Parks and Recreation Department to use photographs of the participants for the promotion of Parks and Recreation programs and events.