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2. Parents Name
3. Child's Name
5. Address
7. Phone Number for Follow-Up
9. School Year
10. Last Day Child Will Be Attending
12. Email for Follow-Up
14. Reason for Leaving (Not Required)
16. Cancellation Policy
    I the undersigned agree to the cancellation policies as outlined below: 1. The registration fee is non-refundable 2. If you need to drop out of class you must inform the Yorkville Parks and Recreation Department by the 20th prior to the month you are not attending. 3. If you do not inform the Yorkville Parks and Recreation Department by the 20th you will forfeit the next month's tuition. 6. Cancellations on or after the first of the month will not be refunded. Questions or concerns on this policy may be addressed with the Superintendent of Recreation.
18. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
20. Electronic Signature
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field