PARKS & RECREATION DEPARTMENT 2021 WINTER/SPRING PROGRAM GUIDE
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PARKS & RECREATION DEPARTMENT 2021 WINTER/SPRING PROGRAM GUIDE
The City of Peekskill ~ Department of Parks & Recreation
1 Robin Drive, Peekskill, NY 10566
Phone: 914-734-7275 Fax: 914-734-4229
www.cityofpeekskill.com/parks-and-recreation
TABLE OF CONTENTS ANDRE RAINEY, MAYOR
VIVIAN C. MCKENZIE, DEPUTY MAYOR
Registration & Department Information…………. 3-4 COMMON COUNCIL
Soccer Programs …..…….. ………………………. 5 Vanessa Agudelo Ramon Fernandez
Winter Youth Basketball Programs……..……….. 6 Patricia Riley Kathleen Talbot
Ice Skating on Lake Mitchell …………………… 7
CITY MANAGER
Maple Sugaring Workshop ………………………. 7
Andrew Stewart
Tennis Programs …..…….. ………………………. 8
Kiley Center Youth Programs…….………………. 9-10
Senior Citizen Programs…………………………… 11
Community Events & Services………………… 12-13
Park Survey ……………………………………… 14-15
RECREATION STAFF
Program Registration Forms……………………… 16
Parks Map and Amenities……………………… 17 CATHERINE MONTALDO
Parks Amenities……………………….………… 18 Superintendent of Recreation
Dana Dapson, Recreation Leader
Tracy Sheridan, Senior Office Assistant
Julius Carrington, Recreation Aide
Dontae Harris, Recreation Aide
PARK ADVISORY BOARD
Marcela Bobe Roy Escobar
Elizabeth Greene Chapman Manzer
Shannon O’Grady Andy Torres
Peekskill Park Advisory Board
Calling all Park Enthusiasts!!!
Are you a citizen of Peekskill who loves our parks and has a vision of how to make them even better? Please
consider applying to be a member of Peekskill’s Parks Advisory Board.
The Parks Advisory Board advises and makes recommendations to the City Manager regarding the improve-
ment, beautification, planning, promotion, and evaluation of the City’s parks & recreational facilities. The Parks
Advisory Board shall make recommendations to the Common Council regarding park improvement, beautifica-
tion, planning, promotion, and evaluation, which require additional funds beyond what is authorized in the ap-
proved City budget.
The Parks Advisory Board meets the second Tuesday of every month, 6:00 pm at the Recreation Office in De-
pew Park.
If you are interested in learning about becoming a member of the Parks Advisory Board, please email us at:
PABinfo@cityofpeekskill.com
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HOW TO REGISTER FOR RECREATION PROGRAMS ONLINE
The City of Peekskill Recreation Department upgraded its registration system to better serve our commu-
nity. We have chosen Community Pass to serve as our registration platform. This platform has allowed
us to offer a less costly and more convenient process for online registration for programs being offered.
To create a family account and register for programs, follow the instructions below or on the Community
Pass site.
How to Create a Family Account:
1. Go to https://www.cityofpeekskill.com/parks-and-recreation
2. From the City of Peekskill Community Pass login homepage click on the ‘Create an Account’ tab.
3. On the next page complete the “Account Creation” fields and click on Create at the bottom of the
page.
4. On the next page you will see the Community Pass Privacy Statement. After reading, click ‘Accept’.
Then click “Finish”.
5. Please save your login and password for future use.
6. If you are unable to successfully create an account, this may mean we may have created one for you.
Please contact our office and we will be happy to assist you.
How to Register for Programs:
1. Provide our office with two proofs of residence.
2. Go to www.cityofpeekskill.com/parks-and-recreation to log back into the system.
3. Log in using the permanent username and password for your account.
4. Click the ‘Click Here to Register’ button.
5. Select the applicable Catalog by clicking the ‘Continue’ button next to your choice.
6. Verify email. Click ‘Continue’.
7. Select the person registering, then ‘Continue’.
8. Select the program(s) you wish to attend.
9. When finished with selections, click ‘Continue’.
10. Complete payment information.
If you have any questions concerning account activation, registration or payments, please call or email:
914-734-7275 or peekskillrec@cityofpeekskill.com.
HOW TO WATCH A GOOD PROGRAM BE ELIMINATED
Nothing kills a recreation program faster than residents who wait until the last minute to register.
There is a point when a program must be cancelled or modified if there is insufficient registration. All
programs require a high level of coordination, often including facility scheduling, staffing, volunteer
recruitment and purchasing of supplies.
PLEASE REGISTER EARLY.
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Legal City of Peekskill residents are defined as those who reside within the City Limits. Two (2) proofs of
residency will be required. An additional fee for non-residents will be charged for all programs and trips. In
all programs, preference for residents will be made.
REGISTRATION INFORMATION
1. The Recreation Office in Depew Park is open from 9:00 am to 4:45 pm, Monday through Friday.
2. You may register by mail. Please include copies of residency proof and make checks payable to “City of Peek-
skill”, unless otherwise stated. Send all information to: Department of Recreation, 1 Robin Drive, Peekskill, NY
10566 or email to peekskillrec@cityofpeekskill.com.
3. Register online with Community Pass at www.cityofpeekskill.com/parks-and-recreation
FORMS OF PAYMENT ACCEPTED
The City of Peekskill Recreation Department accepts cash, checks, money orders, Mastercard and Visa.
ENROLLMENT
For most programs to be conducted, a minimum enrollment must be reached. In addition, there is usually a
maximum enrollment based on the facility size and the instructor’s requirements. Therefore, registration is always on
a first come, first serve basis. We encourage early registration.
SCHOOL FACILITIES
The City of Peekskill wishes to express its appreciation to the Peekskill City School District for its continued
cooperation in allowing the Recreation Dept. use of the public school facilities for recreation programs.
INSURANCE
The City of Peekskill’s Department of Recreation cannot, and does not provide medical insurance for participants in
its programs.
TRIP POLICY
Sign up early. Trips may be canceled without sufficient registration.
CANCELLATION POLICY
Please listen to WLNA-1420 AM, WHUD-100.7 FM or call our hotline at 914-734-4228 for cancellation of programs
due to inclement weather. Classes will be made up at the end of the session. WHEN SCHOOLS ARE CLOSED,
RECREATION PROGRAMS WILL BE CANCELLED. Registrants will also be notified by text and/or e-mail
through Community Pass.
REFUND POLICY
● Refunds will NOT be given after a program begins.
● Refunds can be requested for medical reasons. They must be in writing and they must be accompanied by a
physician’s note.
● Refunds can be requested if the participant is moving from the City.
● Refunds for personal reasons must be made in writing before the program ends. A $15.00 processing fee will be
charged.
RETURN CHECK POLICY
There will be a $25.00 charge for returned checks.
WEBSITE
www.cityofpeekskill.com
SENIOR CITIZEN DISCOUNT
All Peekskill resident senior citizens are entitled to a 10% discount on all programs, and activities with the exception
of trips & programs not payable to the City of Peekskill.
PHOTOGRAPHS FOR BROCHURE
The City of Peekskill Recreation Department would like to express our sincere thanks to the Peekskill in Pictures
Facebook Page for the scenic photographs.
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SOCCER PROGRAMS
INDOOR SOCCER LEAGUE ● #11381
Location: Kiley Youth Center Gymnasium
Dates: January 10 – March 7
Day/Time: Sundays 9:00—10:00 am 7 –9 Years Old
10:00—11:00 am 10-12 Years Old
Game Times TBD
Fee: $55.00
Eligibility: Boys and Girls age 9 - 12
YOUTH SOCCER ● #11380
Location: TBD
Dates: Apr 25 - End of Season
Days/Times: Sundays
Boys & Girls Ages 3 & 4 10:30 am
Boys & Girls Ages 5 & 6 11:30 am
Boys Ages 7- 9 12:30 pm
Boys Ages 10-12 1:30 pm
Fee: Residents $55.00 (Non-residents $80.00)
*GAME TIMES AND LOCATIONS TO BE DETERMINED. THERE MAY BE SOME SATURDAY GAMES.
GIRLS SOCCER ● #11382
Location: TBD
Dates: Apr 25 - End of Season
Days/Times: Sundays
Girls Ages 7– 9 1:30 pm
Girls Ages 10-12 1:30 pm
Fee: Residents $55.00 (Non-residents $80.00)
*GAME TIMES AND LOCATIONS TO BE DETERMINED. THERE MAY BE SOME SATURDAY GAMES.
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WINTER BASKETBALL PROGRAMS
HOT SHOT PROGRAM—BOYS & GIRLS BASKETBALL CLINIC—BOYS & GIRLS
AGES 4 & 5 ● 31340 GRADES 1 & 2 ● 31347
Children will be introduced to the game of basketball by Children will learn the basic skills of dribbling, passing,
learning the basic skills through drills and fun games. shooting and defense through drills and gameplay.
Location: Kiley Center Gymnasium Location: Kiley Center Gymnasium
Date: January 9th (7 weeks) Date: January 9th (7 weeks)
Day/Time: Saturdays, 8:30 am—9:30 am Day: Saturdays
Fee: $50.00 Times: 1st Graders—9:30 am -10:30 am
2nd Graders—10:30 am-11:30 am
Fee: $50.00
PEE WEE BOYS & GIRLS BASKETBALL CUB BOYS & GIRLS BASKETBALL
GRADES 3 & 4 ● 31342 GRADES 5, 6 & 7 ● 31344
Location: Kiley Center Gymnasium Location: Kiley Center Gymnasium
Day/Time: Saturdays 11:30 am—12:30 pm Day/Time: Saturdays 12:30 pm—1:30 pm
January 9th January 9th
Fee: $65.00 Fee: $65.00
Games will be on Saturdays beginning 1/30 if permitted**
Games will be on Saturdays beginning 1/30 if permitted**
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WINTER PROGRAMS
ICE SKATING on Lake Mitchell in Depew Park is permitted ONLY WHEN THE GREEN FLAG IS POSTED!
MAPLE SUGARING WORKSHOP ● #11276
Participants will learn the step-by-step process of how tree sap becomes maple
syrup. Learn how and why sap flows, and how it can become a gallon of maple
syrup. Participants will be encouraged to engage in this hands-on presentation.
Please wear comfortable clothes appropriate for the weather and working
outdoors.
Instructor: John Neering
Location: Maple Sugar Shack in Depew Park
Dates: February 20, February 27 and March 6
Day/Time: Saturdays Session I: 9:00 am—10:30 am
Session II: 11:00 am—12:30 pm
Eligibility: All ages (Children 10 years of age and younger must be
accompanied by an adult)
Fee: $5.00/person ages 3 and up. (Parent free with at least one child).
Please call Recreation Office to register.
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TENNIS PROGRAMS
PEE WEE TENNIS ● #11327
Instructor: Claude Easy
A unique introductory tennis program. This program will feature scaled down equipment and large foam balls, appropri-
ate for small hands and bodies.
Location: Depew Park Tennis Courts
Dates: Apr 24– June 12
Days/Time: Saturdays, 9:00 AM – 10:00 AM
Eligibility: Children ages 5 – 8
Fee: $80.00
YOUTH TENNIS · #11325
Instructor: Claude Easy
This is an introductory, instructional program designed to teach basic skills of tennis. Enjoy learning and playing tennis.
Learn the right grips and improve your footwork and swing. Learn to keep score and have fun playing doubles. Students
do not need to provide their own racquet.
Location: Depew Park Tennis Courts
Dates: Apr 24– June 12
Day/Time: Saturdays, 10:00 AM – 11:00 PM
Eligibility: Children ages 9 – 13
Fee: $80.00
TEEN TENNIS ● #11326
Instructor: Claude Easy
Learn the game of tennis while having fun and getting in shape.
Location: Depew Park Tennis Courts
Dates: Apr 24– June 12
Day/Time: Saturdays, 8:00 AM – 9:00 AM
Eligibility: Ages 14+
Fee: $80.00
ADULT TENNIS LESSONS ● #12325
Instructor: Claude Easy
Location: Depew Park Tennis Courts
Dates: Apr 24 –June 12
Day/Time: Saturdays, 8:00 AM - 9:00 AM
Fee: Residents - $90.00
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KILEY CENTER
Provides Year-Round Supervised Youth Programs
Location: 709 Main Street Phone: (914) 734-4256
Days: Tuesday-Saturday: 3:00 p.m.—9:30 p.m. Fee: FREE but Registration is required
(Age 16 & older until 11:00 p.m.)
Friday & Saturday: 3:00 p.m.—11:00 p.m.
Easter Egg Hunt and Party
Saturday, April 3rd, 2:00 pm
Graduation Cookout & Dance
Friday, June 25th , 4:00 pm
HOMEWORK ASSISTANCE FOR ALL GRADES AVAILABLE TUESDAY—FRIDAY 3PM—4PM
TUESDAY SCHEDULE WEDNESDAY SCHEDULE THURSDAY SCHEDULE
Ages Ages Ages
Board Games 3:30—6:30 6-12 Board Games 3:30—6:30 6-12 Board Games 3:30—6:30 6-12
8:00—9:00 13+ 7:00—9:30 13+ 8:00—9:00 13+
Basketball 3:30—6:30 6-12 Dodgeball/ 4:00 — 7:00 6-12 Basketball 3:30—6:30 6-12
6:30—10:00 13+ Kickball/Tag/Whiffle Ball 6:30—10:00 13+
Table Games 3:30—6:30 6-12 Table Games 3:30—6:30 6-12 Table Games 3:30—6:30 6-12
8:00—9:30 13+ 8:00—9:30 13+ 8:00—9:30 13+
Video Games 5:00—9:30 13+ Computer Lab 4:00—7:00 6+ Video Games 5:00—9:30 13+
Dance 7:00—8:30 8-13 Baseball Drills 5:00—6:30 6-12 Dance 7:00—8:30 8-13
w/ Dache w/ Dache
Basketball 8:30—9:30 13+
Training
SATURDAY SCHEDULE
Dance 7:00—8:30 5-7 Ages
FRIDAY SCHEDULE
w/ Dache
Ages
Board Games 3:30—6:30 6-12
Board Games 3:30—6:30 6-12 7:00—9:30 13+
8:00—9:00 13+
Open Gym 3:00 — 6:00 6-12
Open Gym/ 3:00 — 6:00 6-12 7:00 — 9:00 13+
KanJam/ 7:00— 9:00 13+
Soccer Table Games 3:30—6:30 6-12
8:00—9:30 13+
Table Games 3:30—6:30 6-12
8:00—9:30 13+ Weightlifting 7:00 — 10:00 16+
Video Games 5:00 — 9:30 13+ Video Games 5:00 — 9:30 13+
Dance 7:00—8:30 5-7 Computer Lab 4:00—7:00 6+
w/ Dache
Intro to 5:00—7:00 10-13
Lacrosse
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KILEY CENTER YOUTH PROGRAMS
DANCING WITH DACHE ● #11302 BASKETBALL SKILLS AND DRILLS
Program will focus on hip-hop and street-jazz style of Work on skill development and fundamentals. This is
dance. Class will incorporate stretching, warmup ex- not your playground pickup game, this is for the serious
ercises, and learning choreography. ALL LEVELS individual who wants to be the best they can be.
WELCOME; no prior experience needed. Program
designed to promote creativity, confidence and unity Coordinator: Travis Hutchinson & Philip Tinsley Jr.
amongst students. Dates: Jan 6th—June 26th
Day/Time: Wednesdays 8:30 – 9:30 PM
Coordinator: Dache Leach Saturdays—5:30—6:30 PM
Eligibility: Boys and Girls, 13—17
Session I: Junior Class (Ages 5-7) Fee: FREE. Registration Required.
Wednesdays & Fridays Space is limited.
January 20—March 26 Register at Kiley Center
Senior Class (Ages 8-13)
Tuesdays & Thursdays
January 19—March 25 TEEN SOCCER SKILLS CLINIC
Recital TBD Come learn the basics and develop
your skills.
Session II: Junior Class (Ages 5-7) Coordinator: Dontae Harris
Wednesdays & Fridays Location: Kiley Youth Center
April 21 — June 25 Dates: January 12th—March 9th
Day/Time: Tuesdays 8:00—10:00 PM
Senior Class (Ages 8-13) Eligibility: Boys and Girls, 12—15
Tuesdays & Thursdays Fee: FREE. Registration Required
April 20—June 24
Recital TBD
Time: 7:00 – 8:30 PM
Eligibility: Boys and Girls, 5—13 years old
Fee: FREE. Registration Required.
Space is limited.
Costume Fee $20.00
INTRO TO LACROSSE ● 11301
Calling all Boys and Girls Grades 5th—7th to come learn the basics of Lacrosse from California State University
@ Fresno Defensive Player & 2x Captain Chyna Hill. We supply all equipment needed. This is a non-contact
program. Program is FREE OF CHARGE but registration is required prior to class.
Instructor: Chyna Hill
Location: Kiley Youth Center
Dates: February 6th – March 27th
Day/Time: Saturdays, 5:00 PM – 6:00 PM
Eligibility: Boys & Girls 10-13 Years Old
Fee: FREE! Registration required.
10SENIOR NUTRITION PROGRAM
Our mission is to identify and prioritize the needs of the elderly in Westchester, to create
comprehensive and coordinated plans for meeting those needs; and to advocate for responsive
policies, programs, actions,
SENIOR NUTRITION PROGRAM 100% DELIVERY-ONLY SERVICE
The City of Peekskill Senior Nutrition Program is composed
of two segments; meals served at congregate sites At this time, the Senior Nutrition Program delivers fresh-
throughout the County and the home delivered meals pro- made, hot delicious and nutritious meals Monday through
gram. Each meal provides at least 1/3 of the recommend- Friday.
ed dietary allowance (RDA) for an individual. Both pro-
grams are monitored by the Food and Nutrition Services TO REGISTER CALL: 914-734-4250 Ext. 2
Division, which plans the meals according to standards set
by federal and state regulations and monitors the entire HOMEBOUND PROGRAM
program to ensure compliance with federal, state and coun- Home delivered meals are available for homebound, frail,
ty regulations. elderly City of Peekskill residents, age 60 or over. Home-
bound frail, elderly persons are encouraged to attend the
The NYS Wellness in Nutrition Program (SNAP) aims to congregate site if at all possible.
improve the well-being of those elderly who are at high nu-
tritional risk, with particular emphasis on provision of ser- Hot lunches and cold suppers are delivered Monday
vices to the low income, minority, frail and isolated elderly. through Friday to your door. The suggested contribution for
homebound delivered meals is $3.50 for hot lunch and
Nutrition education and counseling are provided to seniors $2.50 for cold supper.
participating in either the congregate or home delivered
meal programs. Materials and informational programs are Seniors who are homebound are eligible upon initial as-
provided on a regularly scheduled basis and designed to sessment by our Outreach Coordinator; to schedule an in-
assist older persons in making proper choices of food in terview please call 734-4250/4251 – fax 293-0913
order to maintain good health through improved nutritional
status.
SENIOR CITIZEN PROGRAM
PEEKSKILL SENIOR CITIZEN’S CLUB
4 NELSON AVENUE
(914) 734-4254
Club days and hours are Monday – Friday, 9:00 a.m. – 3:00 p.m. The Senior Citizen’s Club provides Social, Recreation-
al, Instructional and Civic Programs to Peekskill Residents 60 years and older. The Club meets five days a week from
9:00 am to 3:00 pm in the lower level of the Neighborhood Center (the Library Bldg.) at 4 Nelson Avenue. A bus shuttle
is available to The Club every day. Additional services include Transportation to our Lunch Program five days a week
and transportation for our scheduled shopping trips two days a week. Information and referral services are available by
appointment.
11COMMUNITY EVENTS & SERVICES
PEEKSKILL VOLUNTEER AMBULANCE CORPS
CPR and First Aid courses will be held periodically. Please contact the Ambulance Corps for information or to schedule
a group for a class. For more information phone 737-5310.
PEEKSKILL’S 31st ANNUAL ST. PATRICK'S DAY PARADE
Sponsored by the Peekskill St. Patrick's Day Parade Committee.
Date/Time: Saturday, March 13th 3:00 PM
12NOR-WEST REGIONAL SPECIAL SERVICES
THERAPEUTIC RECREATION
Director: Chris Morabito
Nor-West operates recreation programs after school or
workshop, evenings and weekends. Special Olympics
sports training, burnin’ music, digital photography, billiards,
swimming, bowling, intro to golf, trip planning via the inter-
net, surfin’ the net, variety club, movies and special events
are included in the schedule. The program is open to all
residents of Cortlandt (including Buchanan, Montrose, Ver-
planck and Croton), Peekskill, Ossining and Yorktown.
Transportation is provided and there is a seasonal registra-
tion fee. Check with us regarding accessibility of each pro-
gram site. For more information call: 737-4797 or 737-
4838.
HUDSON VALLEY REGION OF SPECIAL OLYMPICS
NEW YORK
Regional Director: Joshua Corday
Provides year round sports training and athletic competition
for children and adults with intellectual disabilities who re-
side in Westchester, Putnam, Rockland, Dutchess, Orange,
Ulster & Sullivan Counties. Sports training sites and athlet-
ic venues are located throughout the region. For further
information call: (845) 765-2497, or write 1207 Route 9
Suite 1C, Wappingers Falls, NY 12590.
PEEKSKILL MUSEUM
The Peekskill Museum is dedicated to preserving the Her-
rick House and local historical artifacts. Cast-iron stoves
and plows represent Peekskill’s industrial era. Curious
commercial and domestic items on display make for a
memorable visit. The Peekskill Museum is totally support-
ed by memberships and corporate donations, with no direct
taxpayer or governmental assistance. The Queen Anne
style Victorian home is located at 124 Union Avenue in a
residential neighborhood. The Museum is open to the pub-
lic on Saturdays from 1 to 4 PM. Admission is $2.00 for
adults and $1.00 for children. Call 736-0473 to make a
special appointment.
13The Peekskill Parks Advisory Board is looking for input to help us in our mission to protect, preserve and enhance the city’s
parks and recreation programs. Your feedback is greatly appreciated.
1. What parks do you frequent?
□ Depew Park □ Lepore Park □ Peekskill Landing
□ Charles Point at China Pier □ Monument Park □ Peekskill Stadium
□ Franklin Park □ Neighborhood Center □ Riverfront Green
□ Fort Hill □ Dog Park □ Tompkins Park
2. How often do you visit these parks?
□ Daily □ Weekly □ Monthly □ Seasonally
3. I go to the park to:
□ Exercise □ Site see □ Play Sports □ Watch Sports □ Picnic □ Use Playground □ Walk
Other (please name)
4. This is what I like about Peekskill City Parks:
____________________________________________________________________
5. Peekskill City Parks could be improved by:
____________________________________________________________________
6. On a scale from 1 to 10 (10 being most likely), how likely are you to recommend Peekskill Parks to a friend? ________
7. On a scale from 1 to 10 how likely are you to recommend Peekskill Parks & Recreation programs to a friend? _______
8. In which Parks & Recreation Programs have you participated? ______________________________________________
_________________________________________________________________________________________________
9. Any suggestions for new programs?____________________________________________________________________
_________________________________________________________________________________________________
10. Would you like to be notified of volunteer opportunities to improve and maintain parks? If so, please leave your email
address or the best way to contact you. ________________________________________________________________
Surveys may be returned to the Recreation Office, 1 Robin Drive or faxed to (914) 734-4229.
Thank you for your time and information.
14El comite de los Parques de Peekskill esta buscando ideas para proteger, preservar y mejorar los parques de la ciudad y
programas de recreación. Sus cometarios seran gratamente apreciados.
1. ¿Cuál de los parques frecuenta?
Charles Point at China Pier Fort Hill Peekskill Stadium
Depew Park Franklin Park Pugsley Park
Dog Park Lepore Park Riverfront Green
Fireman’s Park McKinley Park Tompkins Park
2. ¿Con qué frecuencia visita estos parques?
Diario Semanal Mensual Según la temporada
3. Yo voy al parque a:
Ejercicios Ver el sitio Hacer deportes Picnic Utilizar el campo de juegos Caminar
Ver los eventos deportivos Otros (por favor nombre) ________________________________
4. Esto es lo que me gusta de los Parques de la Ciudad de Peekskill:
_______________________________________________________________
5. Los Parques de la ciudad de Peekskill podrían mejorarse a través de:
_______________________________________________________________
6. ¿En qué programa de los Parques de Recreación a participado?
_______________________________________________________________
7. ¿Tienes alguna sugerencia para nuevos programas?
________________________________________________________________
La encuesta puede ser devuelta a la Oficina de Recreación, 1 Robin Drive o por fax al 914-734-4229.
Gracias por su tiempo y su información.
15-———————----------------------------------------------------------------------------------------------------------------
PROGRAM REGISTRATION FORM
Name: __________________________________ Date of Birth ______________Sex:___M___F
Address:______________________________________________________________________
School:______________________________________________________ Grade:___________
Phone: (C) __________________ (H) ___________________ Email:_______________________
Program #: ______________________________ Session #: ______________
Senior Citizen ? _________________ Proof of Residency attached?____________________
Amount Enclosed: ________________________________
---------------------------------------------------------------------------——————---------------------------------------
PROGRAM REGISTRATION FORM
Name: __________________________________ Date of Birth ______________Sex:___M___F
Address:______________________________________________________________________
School:______________________________________________________ Grade:___________
Phone: (C) __________________ (H) ___________________ Email:_______________________
Program #: ______________________________ Session #: ______________
Senior Citizen ? _________________ Proof of Residency attached?____________________
Amount Enclosed: ________________________________
---------------------------------------------------------------------------------——————---------------------------------
PROGRAM REGISTRATION FORM
Name: __________________________________ Date of Birth ______________Sex:___M___F
Address:______________________________________________________________________
School:______________________________________________________ Grade:___________
Phone: (C) __________________ (H) ___________________ Email:_______________________
Program #: ______________________________ Session #: ______________
Senior Citizen ? _________________ Proof of Residency attached?____________________
Amount Enclosed: ________________________________
------------------------------------------------------------------------------------------------------------------
PROGRAM REGISTRATION FORM
Name: __________________________________ Date of Birth ______________Sex:___M___F
Address:______________________________________________________________________
School:______________________________________________________ Grade:___________
Phone: (C) __________________ (H) ___________________ Email:_______________________
Program #: ______________________________ Session #: ______________
Senior Citizen ? _________________ Proof of Residency attached?____________________
Amount Enclosed: ________________________________
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