Winter 2012 Program Sign-Up
Complete this form to sign up any interested persons for programs. BEFORE you complete this form, please fill out the "New Client Registration Form" by clicking HERE. You only have to fill out the new client form one time for all of 2012. If you have already completed this form you are SET! Then, you can select which programs you would like to participate in by filling out the form below. If you have questions, please call 920.448.7340 and someone would be happy to assist you.
First Name:
Last Name:
Age:
CHILDREN'S PROGRAMMING:
First Name:
Last Name:
Age:
First Name:
Last Name:
Age:
ADULTS' PROGRAMMING:
First Name:
Last Name:
First Name:
Last Name:
By typing your full name below, you agree to the following:
I give my permission for those listed above to be photographed or video taped by Howe Neighborhood Family Resource Center, partners, and/or media for news coverage, documentation, and program promotion. I give my permission for those above to participate in all activities involved with this program. In the event of an emergency, I authorize any medical treatment that may be needed if I cannot be immediately reached. In case of accident or injury, I hereby release Howe Neighborhood Family Resource Center and their staff and volunteers from any liability of wrongdoing.
First Name:
Last Name:
Release and Consent:
