Class Registration Form

City of Fullerton

Instructions

Make sure you've read the general information applicable to all classes.
Print this web page using your browser.
Fill in the blanks below. Please print.
Sign the Release Agreement at the end.
Fill out the credit card information or make check payable to 'City of Fullerton'.
Print a copy of the class description from the corresponding web page for your future reference.
Choose one of the following:

Mail In

Simply fill out the adjacent registration form, write a check for each class or fill in the information for your credit card and mail to us.

Please make check payable to "City of Fullerton" and mail with your registration form to:
Spring Registration
Community Services
303 W. Commonwealth
Fullerton, CA 92632

Phone-In / Fax-In

If you are using your MasterCard or Visa to register, you may phone in or Fax in your registration. Please have your charge card handy. If you are calling from outside the 714 area code, use our new toll-free phone number: 1-800-438-6473. Otherwise use 714-738-6575 or fax your registration form to 714-738-6599.

Walk-In

You can bring your registration to City Hall at th above address between 8am and 5pm, Monday-Friday, or Independence Park or the Fullerton Museum Center on Thursday evenings between 5pm and 9pm.

Classroom

If it does not say 'no classroom registration' in the Note section of the class description, you can attend the first class session and register with the instructor.

Adult Last Name: _____________________  First: __________  M.I.: _____

Address:  ____________________________________________________________

City: ____________________________________________  ZIP: _____________

Day Phone: (   )____-______            Evening Phone: (   )____-______

Emergency Contact Person: ______________________________

Emergency Phone: (   )____-______


How did you hear about our programs?
[  ] Recreation Brochure
[  ] Newspaper
[  ] Flyer 
[  ] Word of Mouth
[  ] Online
[  ] Other ___________________________________________________________


============================================================================
Class# | Class         | Participant's          | Date of Birth | Sex | Fee
       | Name          | Full Name              | (if under 18) |     |     
=======|===============|========================|===============|=====|=====
       |               |                        |               |     |
       |               |                        |    /    /     | M/F |
=======|===============|========================|===============|=====|=====
       |               |                        |               |     |
       |               |                        |    /    /     | M/F |
=======|===============|========================|===============|=====|=====
       |               |                        |               |     |
       |               |                        |    /    /     | M/F |
=======|===============|========================|===============|=====|=====
                                                                      |
                          Non-residents of Fullerton add $6 per class:|_____
                                                                      |
                                       Secret Pal Donation (optional):|$1.00
                                                                      |
                                                    Total Amount Paid:|_____

Check # __________

or

[ ] Visa [ ] Mastercard

#_______-_______-_______-_______ Exp.Date: ____/____

[ ] I am enclosing a stamped, self-addressed envelope for computer receipt of registration.
You will not receive a receipt of registration unless you check the box above. Consider yourself registered unless you are notified otherwise by the Department.

If you need special accomodations for any of our activities, please notify the staff at the time you register.

Release of Liability

I absolve and agree to hold harmless the City of Fullerton, its employees, offices or agents from any liability which may result from my participation or that of any minor in my legal custody in the above activity.I give permission for his/her participation in the above activity and for any necessary emergency medical treatment.

I, THE UNDERSIGNED, CERTIFY THAT I HAVE READ AND UNDERSTAND THIS WAIVER AND RELEASE AS IT APPLIES TO MYSELF AND TO ANY MINORS FOR WHOM I AM SIGNING.

Participant Signature: ___________________________________ Date: __________
(Parent or guardian must sign for participants under 18 years of age)

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