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Registration form



Participants Name:________________________________________________
Home Phone:__________________ Work/Cell Phone ____________________
Please list any physical limitations/restrictions and/or medications taken & food allergies: __________________________________________________________________________________________

Must be completed if participant is under 18 years of age:

DOB: _______ Age:_______ Grade in FALL________ Gender:_____
Parent(s) Name: _______________________________________________
Home Phone: _____________ Work/cell Phone: ______________________
Emergency contact if we can’t reach parent.
Name: ___________________________________________Phone________________________________

Program Title
Late Fee (1 week prior to start of program)

NO PROGRAM CONFIRMATION WILL BE SENT OUT: Participants should consider their applications accepted and report to class for the first meeting unless otherwise notified.. The only time you will hear from us is if there is a change in the time, if a class/program is full and you have been placed on a wait list, or if the class/program has been canceled.
REFUND POLICY: There will be no refunds for programs; you will get a credit towards other programs. This does not apply to programs that are canceled due to low enrollment or if it is full.
Classes will be cancelled due to low enrollment.  
Any registration forms received less than 1 week prior to the start of the program will be subject to a $10 additional fee. (This does not apply to adult fitness classes)
There is a $25.00 service fee to The Town of Rutland, for all returned checks.
Make checks payable: Town of Rutland Mail to Rutland Recreation 250 Main St. Rutland MA 01543 or drop off at the Town Hall.  Cash not accepted at drop in fitness classes.

For Office use Only: Date Received_____________ Check # __________ Cash ____________ Amount _____________

Town of Rutland 250 Main Street, Rutland, MA 01543   Disclaimer
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