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)
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| Check |
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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:__________ | |