Mail-In Registration Form Mail to: Capitola Recreation Department 4400 Jade Street, Capitola, CA. 95010 |
Note: This is not an on-line registration form
| Your Name: | _____________________________________________________ | |||||
| Address: | _____________________________________________________ | |||||
| City/Zip: | _____________________________________________________ | |||||
| Home Phone: | _____________________ | Work Phone: | ____________________ | |||
| Participant's Name | Birth Date | Class # | Name of Class | Day & Time | Total Fee |
|---|---|---|---|---|---|
| Total Amount Due (Do not include Materials Fees): | |||||
Payment Method: (Note: Capitola Recreation has a No Refund policy)
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| Check |
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Please make checks payable to: Capitola Recreation Department.
Credit cards: Visa or MasterCard only. In signing below, I accept the terms that Capitola Recreation has a No Refund policy (unless Capitola Recreation cancels a class):
| Cardholder's Signature: | ____________________________________________________________________________________ | |
| Print Cardholder's Name: | ____________________________________________________________________________________ | |
| Credit Card #: | _____________________________________ Expiration Date:__________ | |