Page 4 - brochure summer20.pmd

VISIT OUR OFFICE FAX REGISTRATION:
Registration Form
All registrations in person are accepted at the Parks (763) 421-7624
and Public Works Building, 11955 Champlin Drive. Register by fax for all classes unless the activity
The office is open from 8:00 a.m. to 4:30 p.m., description lists special registration procedures. Just
Monday - Friday. A $5.00 late fee will be assessed to fill out the registration form below and fax it along
all programs after registration deadline. with your credit card information to (763) 421-7624.

MAIL REGISTRATION FORM VISIT OUR WEBSITE:
Register by mail for all classes unless the activity lists www.ci.champlin.mn.us
special registration procedures. Fill out the registration
form below and send it along with your check or credit Simply visit our homepage at www.ci.champlin.mn.us
and click on the link to online registration. A
card number to the Champlin Parks and Recreation, username and password needs to be established before
11955 Champlin Drive, Champlin, MN 55316.
your first registration. Credit card payments are
accepted online on our secure website.
USE OUR 24-HOUR DROP BOX Online Registration (how to)
There is a drop box located on the sidewalk in front of 1. Go to www.ci.champlin.mn.us
the Parks & Public Works Building for your 2. Click link for Parks and Recreation
convenience. Place your registration form and pay- 3. Click on online registration
ment in the drop box and your registration will be 4. Sign-in or register
processed the following morning. 5. Select Program and register!

Champlin Parks & Recreation Summer 2020

PARTICIPANT'S NAME BIRTHDATE GENDER ACTIVITY ACTIVITY # FEE
2020.
2020.
2020.
REGISTRATION DEADLINE IS ONE WEEK PRIOR TO START DATE UNLESS OTHERWISE NOTED. TOTAL

PARENTS’ NAME (if participant is under 18)__________________________________________________________________________________

ADDRESS_____________________________________________________CITY______________________________________ZIP____________________
PHONE_______________________________________________EMAIL___________________________________________________________________

ALLERGIES OR SPECIAL NEEDS______________________________________________________________________________________________

WAIVER FOR PARTICIPANT
In consideration of your accepting this registration, I hereby, for myself, my heirs, executors and administrators, waive and release
any and all rights and claims for damages I may have against the Champlin Parks & Recreation Department providing this activity,
and its representatives, successors, and assigns for any and all injuries suffered by myself or my child at any activity sponsored by
this group.
SIGNATURE (parent signature if under 18)___________________________________________________________________________________

CREDIT CARD PAYMENT VISA MASTERCARD DISCOVER
ACCOUNT #: _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____

EXP DATE: ____________ / ____________ 3 DIGIT SECURITY NO: _____ _____ _____

IF DIFFERENT FROM ABOVE
CARD HOLDER NAME (printed on card) ____________________________________________________________________________________
BILLING ADDRESS___________________________________________ CITY____________________________________ZIP___________________
PHONE_________________________________________________ EMAIL_______________________________________________________________

SIGNATURE______________________________________________________________________________DATE________________________________

4 763-421-2820