Mail-In / Fax-In Registration Form
Mail to: Capitola Recreation Department
4400 Jade Street, Capitola, CA. 95010
Fax-In Phone Number: 475-6279

Note: This is not an on-line registration form

PLEASE NOTE: We cannot accept fax-in registration for Camp, Junior Guards or Aquatics; for legal reasons, we need the ORIGINAL forms. For Camp and Aquatics, you can print out this form and the Medical, Liability, and other forms from the web page for those programs and mail them in. To manage priority registration and new registration for Junior Guards, registration can only be done in person, at our office.
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)
Check

Please make checks payable to: Capitola Recreation Department

FOR FAXES: dial 475-6279 (Use this form and pay with Visa or Master Card 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:__________