REGISTRATION FORM You can fill out this form, print it and mail it to: LATROBE - UNITY PARKS & RECREATION PO BOX 307 LATROBE PA 15650-0307
OR
Fax it with your credit card information to:
724-537-2057
PARTICIPANT INFORMATION: (PLEASE NOTE: ONE REGISTRATION FORM IS NEEDED PER PARTICIPANT) Last Name: First Name: MI Address: City: State: Zip: Area Code: Phone: Gender DOB: Age E-mail Address Grade:
School Attending: Health Problems: Physician:
Physician's Phone: Residing Township: Residency: (Please Check One) Greater Latrobe School District Outside Greater Latrobe School District Emergency Contact: Phone:
In order for LUP&R & UWWC to better serve our community needs - please answer the following questions:
Black or African American Caucasian American Indian or Alaska Native Asian Native Hawaiian & Other Pacific Islander Hispanic or Latino Other Race Below $15,000 $16,000 - $19,999 $20,000 - $34,999 $35,000 - $49,999 $50,000 - $74,999 $75,000 - $99,999 $100,000 - $149,999 $150,000 and Over Household Income
Program: Adult Lap Swim Amphibians Alive Babysitter Training Course - Session 1 Babysitter Training Course - Session 2 Babysitter Training Course - Session 3 Babysitter Training Course - Session 4 Babysitter Training Course - Session 5 Basketball - Summer Clinic for Boys Basketball - Summer Clinic for Girls Basketball - Mens Summer Basketball - Youth Summer Hoops League Baseball - Age 5 Baseball - Age 6 Baseball - Age 7 Baseball - Little Sluggers Bowling - Latrobe Alleycats Session 1 Bowling - Latrobe Alleycats Session 2 Bubblemaker Bus Trip - Mountaineer Racetrack Bus Trip - Mountain Playhouse Bus Trip - Pirates Childrens Swimming Lessons - Saturdays Childrens Swimming Lessons - Session 1 Childrens Swimming Lessons - Session 2 Childrens Swimming Lessons - Session 3 Dek Hockey - Commanders Dek Hockey - Corporals Dek Hockey - Sergeants Diving Lessons - Session 1 Diving Lessons - Session 2 Dragonfly & Butterfly Hunt Easter Egg Hunt Field Hockey for Girls Golf - Adult Golf - Junior Guard Start Gymnastics - CheerNastics Gymnastics - Mommy & Me Gymnastics - Gymnastics Fundamentals Gymnastics - Pre-School Gymnastics Insect Safari Intro to Archery - Indoor Intro to Archery - Outdoor Judo - Adults Session 1 Judo - Adults Session 2 Judo - Kids Session 1 Judo - Kids Session 2 Kids Ecoventure Kid-Fit Session 1 Kid-Fit Session 2 Kid-Fit Session 3 Kid-Fit Session 4 Lacrosse - Boys Lacrosse - Girls Summer Camp Lacrosse - Girls Summer League Lifeguard Certification One Stroke Painting for Adults Picnic in the Park Pirates Buried Treasure Playgrounds - 1st Ward Playgrounds - 3rd Ward Playgrounds - Athletic Field Playgrounds - Baggaley Elementary School Playgrounds - Crabtree (St. Bartholomew's Church) Playgrounds - East High Acres Playgrounds - Hostetter Slovak Club Playgrounds - Irving Ave. Playgrounds - Lawson Heights (Prince of Peace Church) Playgrounds - Marguerite Central Park Playgrounds - Mt. View Elementary School Playgrounds - Pleasant Unity Playgrounds - Wimmerton Pre-School Intro to H2O - Saturdays Pre-School Intro to H2O - Session 1 Pre-School Intro to H2O - Session 2 Pre-School Intro to H2O - Session 3 Private Swimming Lessons Rugrats in the Wild Soccer - Summer Soccer Camp Soccer - U10 Travel CO-ED Soccer - U12 Travel Boys and Girls Soccer - U14 Travel Girls Soccer - In House U11 Soccer - My First Kick Session 1 Soccer - My First Kick Session 2 Soccer - Sharks Soccer - U 8 Co-ed Stained Glass Workshop Tai Chi - Session 1 Tai Chi - Session 2 Tennis - Beginner @ GLSH Session 1 Tennis - Beginner @ GLSH Session 2 Tennis - Beginner @ LK Session 1 Tennis - Beginner @ LK Session 2 Tennis - Future Stars Session 1 Tennis - Future Stars Session 2 Tennis - Juniors @ GLSH Session 1 Tennis - Juniors @ GLSH Session 2 Tennis - Pee Wee Session 1 Tennis - -Pee Wee Session 2 Volleyball Clinic Volleyball - Cool Cats Sand League Volleyball - Power Sand Tournaments Volleyball - Varsity Camp Strength Training Yoga - Session 1 Yoga - Session 2 Yoga - Session 3 Yoga - Session 4 Please Choose From The List Fee: Add 10% if registering after the deadline Program: Adult Lap Swim Amphibians Alive Babysitter Training Course - Session 1 Babysitter Training Course - Session 2 Babysitter Training Course - Session 3 Babysitter Training Course - Session 4 Babysitter Training Course - Session 5 Basketball - Summer Clinic for Boys Basketball - Summer Clinic for Girls Basketball - Mens Summer Basketball - Youth Summer Hoops League Baseball - Age 5 Baseball - Age 6 Baseball - Age 7 Baseball - Little Sluggers Bowling - Latrobe Alleycats Session 1 Bowling - Latrobe Alleycats Session 2 Bubblemaker Bus Trip - Mountaineer Racetrack Bus Trip - Mountain Playhouse Bus Trip - Pirates Childrens Swimming Lessons - Saturdays Childrens Swimming Lessons - Session 1 Childrens Swimming Lessons - Session 2 Childrens Swimming Lessons - Session 3 Dek Hockey - Commanders Dek Hockey - Corporals Dek Hockey - Sergeants Diving Lessons - Session 1 Diving Lessons - Session 2 Dragonfly & Butterfly Hunt Easter Egg Hunt Field Hockey for Girls Golf - Adult Golf - Junior Guard Start Gymnastics - CheerNastics Gymnastics - Mommy & Me Gymnastics - Gymnastics Fundamentals Gymnastics - Pre-School Gymnastics Insect Safari Intro to Archery - Indoor Intro to Archery - Outdoor Judo - Adults Session 1 Judo - Adults Session 2 Judo - Kids Session 1 Judo - Kids Session 2 Kids Ecoventure Kid-Fit Session 1 Kid-Fit Session 2 Kid-Fit Session 3 Kid-Fit Session 4 Lacrosse - Boys Lacrosse - Girls Summer Camp Lacrosse - Girls Summer League Lifeguard Certification One Stroke Painting for Adults Picnic in the Park Pirates Buried Treasure Playgrounds - 1st Ward Playgrounds - 3rd Ward Playgrounds - Athletic Field Playgrounds - Baggaley Elementary School Playgrounds - Crabtree (St. Bartholomew's Church) Playgrounds - East High Acres Playgrounds - Hostetter Slovak Club Playgrounds - Irving Ave. Playgrounds - Lawson Heights (Prince of Peace Church) Playgrounds - Marguerite Central Park Playgrounds - Mt. View Elementary School Playgrounds - Pleasant Unity Playgrounds - Wimmerton Pre-School Intro to H2O - Saturdays Pre-School Intro to H2O - Session 1 Pre-School Intro to H2O - Session 2 Pre-School Intro to H2O - Session 3 Private Swimming Lessons Rugrats in the Wild Soccer - Summer Soccer Camp Soccer - U10 Travel CO-ED Soccer - U12 Travel Boys and Girls Soccer - U14 Travel Girls Soccer - In House U11 Soccer - My First Kick Session 1 Soccer - My First Kick Session 2 Soccer - Sharks Soccer - U 8 Co-ed Stained Glass Workshop Tai Chi - Session 1 Tai Chi - Session 2 Tennis - Beginner @ GLSH Session 1 Tennis - Beginner @ GLSH Session 2 Tennis - Beginner @ LK Session 1 Tennis - Beginner @ LK Session 2 Tennis - Future Stars Session 1 Tennis - Future Stars Session 2 Tennis - Juniors @ GLSH Session 1 Tennis - Juniors @ GLSH Session 2 Tennis - Pee Wee Session 1 Tennis - -Pee Wee Session 2 Volleyball Clinic Volleyball - Cool Cats Sand League Volleyball - Power Sand Tournaments Volleyball - Varsity Camp Strength Training Yoga - Session 1 Yoga - Session 2 Yoga - Session 3 Yoga - Session 4 Please Choose From The List Fee: Add 10% if registering after the deadline Program: Adult Lap Swim Amphibians Alive Babysitter Training Course - Session 1 Babysitter Training Course - Session 2 Babysitter Training Course - Session 3 Babysitter Training Course - Session 4 Babysitter Training Course - Session 5 Basketball - Summer Clinic for Boys Basketball - Summer Clinic for Girls Basketball - Mens Summer Basketball - Youth Summer Hoops League Baseball - Age 5 Baseball - Age 6 Baseball - Age 7 Baseball - Little Sluggers Bowling - Latrobe Alleycats Session 1 Bowling - Latrobe Alleycats Session 2 Bubblemaker Bus Trip - Mountaineer Racetrack Bus Trip - Mountain Playhouse Bus Trip - Pirates Childrens Swimming Lessons - Saturdays Childrens Swimming Lessons - Session 1 Childrens Swimming Lessons - Session 2 Childrens Swimming Lessons - Session 3 Dek Hockey - Commanders Dek Hockey - Corporals Dek Hockey - Sergeants Diving Lessons - Session 1 Diving Lessons - Session 2 Dragonfly & Butterfly Hunt Easter Egg Hunt Field Hockey for Girls Golf - Adult Golf - Junior Guard Start Gymnastics - CheerNastics Gymnastics - Mommy & Me Gymnastics - Gymnastics Fundamentals Gymnastics - Pre-School Gymnastics Insect Safari Intro to Archery - Indoor Intro to Archery - Outdoor Judo - Adults Session 1 Judo - Adults Session 2 Judo - Kids Session 1 Judo - Kids Session 2 Kids Ecoventure Kid-Fit Session 1 Kid-Fit Session 2 Kid-Fit Session 3 Kid-Fit Session 4 Lacrosse - Boys Lacrosse - Girls Summer Camp Lacrosse - Girls Summer League Lifeguard Certification One Stroke Painting for Adults Picnic in the Park Pirates Buried Treasure Playgrounds - 1st Ward Playgrounds - 3rd Ward Playgrounds - Athletic Field Playgrounds - Baggaley Elementary School Playgrounds - Crabtree (St. Bartholomew's Church) Playgrounds - East High Acres Playgrounds - Hostetter Slovak Club Playgrounds - Irving Ave. Playgrounds - Lawson Heights (Prince of Peace Church) Playgrounds - Marguerite Central Park Playgrounds - Mt. View Elementary School Playgrounds - Pleasant Unity Playgrounds - Wimmerton Pre-School Intro to H2O - Saturdays Pre-School Intro to H2O - Session 1 Pre-School Intro to H2O - Session 2 Pre-School Intro to H2O - Session 3 Private Swimming Lessons Rugrats in the Wild Soccer - Summer Soccer Camp Soccer - U10 Travel CO-ED Soccer - U12 Travel Boys and Girls Soccer - U14 Travel Girls Soccer - In House U11 Soccer - My First Kick Session 1 Soccer - My First Kick Session 2 Soccer - Sharks Soccer - U 8 Co-ed Stained Glass Workshop Tai Chi - Session 1 Tai Chi - Session 2 Tennis - Beginner @ GLSH Session 1 Tennis - Beginner @ GLSH Session 2 Tennis - Beginner @ LK Session 1 Tennis - Beginner @ LK Session 2 Tennis - Future Stars Session 1 Tennis - Future Stars Session 2 Tennis - Juniors @ GLSH Session 1 Tennis - Juniors @ GLSH Session 2 Tennis - Pee Wee Session 1 Tennis - -Pee Wee Session 2 Volleyball Clinic Volleyball - Cool Cats Sand League Volleyball - Power Sand Tournaments Volleyball - Varsity Camp Strength Training Yoga - Session 1 Yoga - Session 2 Yoga - Session 3 Yoga - Session 4 Please Choose From The List Fee: Add 10% if registering after the deadline Program: Adult Lap Swim Amphibians Alive Babysitter Training Course - Session 1 Babysitter Training Course - Session 2 Babysitter Training Course - Session 3 Babysitter Training Course - Session 4 Babysitter Training Course - Session 5 Basketball - Summer Clinic for Boys Basketball - Summer Clinic for Girls Basketball - Mens Summer Basketball - Youth Summer Hoops League Baseball - Age 5 Baseball - Age 6 Baseball - Age 7 Baseball - Little Sluggers Bowling - Latrobe Alleycats Session 1 Bowling - Latrobe Alleycats Session 2 Bubblemaker Bus Trip - Mountaineer Racetrack Bus Trip - Mountain Playhouse Bus Trip - Pirates Childrens Swimming Lessons - Saturdays Childrens Swimming Lessons - Session 1 Childrens Swimming Lessons - Session 2 Childrens Swimming Lessons - Session 3 Dek Hockey - Commanders Dek Hockey - Corporals Dek Hockey - Sergeants Diving Lessons - Session 1 Diving Lessons - Session 2 Dragonfly & Butterfly Hunt Easter Egg Hunt Field Hockey for Girls Golf - Adult Golf - Junior Guard Start Gymnastics - CheerNastics Gymnastics - Mommy & Me Gymnastics - Gymnastics Fundamentals Gymnastics - Pre-School Gymnastics Insect Safari Intro to Archery - Indoor Intro to Archery - Outdoor Judo - Adults Session 1 Judo - Adults Session 2 Judo - Kids Session 1 Judo - Kids Session 2 Kids Ecoventure Kid-Fit Session 1 Kid-Fit Session 2 Kid-Fit Session 3 Kid-Fit Session 4 Lacrosse - Boys Lacrosse - Girls Summer Camp Lacrosse - Girls Summer League Lifeguard Certification One Stroke Painting for Adults Picnic in the Park Pirates Buried Treasure Playgrounds - 1st Ward Playgrounds - 3rd Ward Playgrounds - Athletic Field Playgrounds - Baggaley Elementary School Playgrounds - Crabtree (St. Bartholomew's Church) Playgrounds - East High Acres Playgrounds - Hostetter Slovak Club Playgrounds - Irving Ave. Playgrounds - Lawson Heights (Prince of Peace Church) Playgrounds - Marguerite Central Park Playgrounds - Mt. View Elementary School Playgrounds - Pleasant Unity Playgrounds - Wimmerton Pre-School Intro to H2O - Saturdays Pre-School Intro to H2O - Session 1 Pre-School Intro to H2O - Session 2 Pre-School Intro to H2O - Session 3 Private Swimming Lessons Rugrats in the Wild Soccer - Summer Soccer Camp Soccer - U10 Travel CO-ED Soccer - U12 Travel Boys and Girls Soccer - U14 Travel Girls Soccer - In House U11 Soccer - My First Kick Session 1 Soccer - My First Kick Session 2 Soccer - Sharks Soccer - U 8 Co-ed Stained Glass Workshop Tai Chi - Session 1 Tai Chi - Session 2 Tennis - Beginner @ GLSH Session 1 Tennis - Beginner @ GLSH Session 2 Tennis - Beginner @ LK Session 1 Tennis - Beginner @ LK Session 2 Tennis - Future Stars Session 1 Tennis - Future Stars Session 2 Tennis - Juniors @ GLSH Session 1 Tennis - Juniors @ GLSH Session 2 Tennis - Pee Wee Session 1 Tennis - -Pee Wee Session 2 Volleyball Clinic Volleyball - Cool Cats Sand League Volleyball - Power Sand Tournaments Volleyball - Varsity Camp Strength Training Yoga - Session 1 Yoga - Session 2 Yoga - Session 3 Yoga - Session 4 Please Choose From The List Fee: Add 10% if registering after the deadline
TOTAL AMOUNT:
Shirt Size: Child Small (6-8) Child Medium (10-12) Child Large (14-16) Adult Small Adult Medium Adult Large Adult X-Large Adult XX-Large (Add $2.00) Blank Short Size: Child Small (6-8) Child Medium (10-12) Child Large (14-16) Adult Small Adult Medium Adult Large Adult X-Large Adult XX-Large (Add $2.00) Blank
I, in consideration of my (or my child's participation) in this activity, hereby release Latrobe - Unity Parks & Recreation, the City of Latrobe, the Greater Latrobe School District, (at any program location) and any individual connected herewith from any and all property damage or liability arising from accident, injury or illness suffered as a result of participation in this activity.
Your Signature (Parent, if participant is under 18)
Payment Information:
Check Credit Card Credit Card Type: Visa Master Card Discover Credit Card #:
Expiration Date: V-Code: (last 3 digits on back of card) Name on Card:
Billing Street Address :