Fall Program Registration Form (PDF)

Waterford Recreation & Parks Commission
Fall 2022 REGISTRATION FORM
Please complete the registration form below, including all pertinent information, and return the completed form with 
payment to the Recreation and Parks Office.
Accepted Form of Payment: Cash, check or credit (NO AMX). Checks should be made payable to the Town of Waterford 
(unless noted). PLEASE FILL OUT REGISTRATION FORM COMPLETELY - CODE NUMBERS are essential in 
securing the right program. 
	
	
August 15	
Residents – Mail in - Postmarked after August 15
	
	
August 22	
Residents – Online Opens	
Non-Residents – Mail-in
	
	
August 25	
Non-Residents – Online Opens
	
	
August 29	
Open in-office registration
	
	
Any registrations received before the post mark date of August 15 will be returned.
	
Mail completed form and payment to:	
Recreation and Parks 
	
	
15 Rope Ferry Rd.
	
	
Waterford, CT 06385	
	
	
NAME: ________________________________________________________________________________________
ADDRESS: ____________________________________________________________________________________
PHONE: ______________________________  E-MAIL:_________________________________________________
Waterford Senior Citizen Age is 65
         Code #	   	
Program Name	
Participants Name            M/F	
Date of Birth/Age 	
    Fee
1.____________________________________________________________________________________________ 
2.____________________________________________________________________________________________ 
3.____________________________________________________________________________________________
Total Fees: ____________
In the event a class is full or canceled, we will try to place you in another class.  
Otherwise, the registration fee will be refunded.
Allergies:________________________________________________________________________________
Comments/suggestions:___________________________________________________________________
Emergency Contact: Name: ______________________________________ Phone: _________________________
In consideration for participating in activities sponsored by the Town Of Waterford, I hereby waive and release the Town Of Waterford, 
it’s agents, officers and employees, whether paid or voluntary, from and against any and all claims, suits, actions, damages, liabilities, 
costs, expenses, and or judgments, including attorney’s fees and court costs, which may arise from my participation in activities or 
nay illness or injury resulting there from, either directly or incidentally. I hereby represent that I understand and am familiar with the 
nature and type of activities in which I participate in. I acknowledge that I will be solely responsible for the furnishing of necessary 
safeguards and appropriate equipment for protection against injury. Photos taken during programs may be used for promotional 
purposes. Please notify Recreation and Parks if you do not want picture published. I have read this document, understand, and 
agree to its terms and conditions. I also give permission to use photo’s taken during classes, programs and activities for promotion 
of myself/and/or child. Please note that all Waterford Recreation and Parks Programs do not fall under state camps or state certified 
activities and/or programs.
By signing you are agreeing to the terms set above and agree to follow all Town and Recreation and Parks set rules and regulations. 
Signature _________________________________________________Date:______________________
	
	
	
	
Participant OR parent if participant is under 18
Please use the back of the form for additional registrations. Any unsigned registrations or checks are required to be 
returned. Please review all of the materials before submitting. Email information allows receipts to be sent electronically 
and class updates to be emailed.