Page 35 - Experience Wyoming - Summer 2022

REGISTRATION FORM

Ways to PROGRAM Parks & Recreation Office
1155 – 28th St. SW
REGISTER: REFUNDS: Wyoming, MI 49509
616-530-3164/Fax 616-249-3400
The Parks & Recreation Department does
not offer program refunds unless a class Monday-Thursday: 7:00 am-5:00 pm
Online - www. wyomingmi.gov/PRRegistration
is cancelled because of low enrollment Wyoming Senior Center
Phone - 616-530-3164 or because a change in class day, time or 2380 DeHoop SW
site after registration is taken prevents an Wyoming, MI 49509
Mail - Mail form to appropriate office below. 616-530-3190/Fax 616-261-3599
individual’s participation.
4In Person - Stop by our office. Monday-Thursday: 7:00 am-5:00 pm
Saturday: 8:00 am-3:00 pm
HOUSEHOLD INFORMA TION
PARENT/GUARDIAN PARENT/GUARDIAN
FIRST NAME LAST NAME

ADDRESS BIRTH DATE

CITY STATE ZIP HOME PHONE
DAYTIME PHONE CELL PHONE
E-mail address allows us to: send receipts, class updates/
E-MAIL ADDRESS cancellations, registration forms and promotional materials

ENROLLEE INFORMA TION
FIRST NAME LAST NAME MALE / FEMALE BIRTH DATE AGE GRADE SCHOOL NAME
ACTIVITY NAME ACTIVITY # SECTION START TIME DATE BEGINS FEE
$

$

FIRST NAME LAST NAME MALE / FEMALE BIRTH DATE AGE GRADE SCHOOL NAME
ACTIVITY NAME ACTIVITY # SECTION START TIME DATE BEGINS FEE

$
$

FIRST NAME LAST NAME MALE / FEMALE BIRTH DATE AGE GRADE SCHOOL NAME
ACTIVITY NAME ACTIVITY # SECTION START TIME DATE BEGINS FEE
$
$

Please make checks or money orders payable to: City of Wyoming Total Amount Enclosed $

Credit Card Information:

Signature Card # CVV # (3 digit code on back of card) Exp. Date

SUMMER ~ WYOMING PARKS & RECREATION 35