Class Registration Form

City of Santa Ana

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.
Make check payable to 'City of Santa Ana'. Do not send cash.
Enclose a stamped, self-addressed envelope so your registration receipt can be returned (except Tennis classes).
Print a copy of the class description from the corresponding web page for your future reference.
Choose one of the following:

Mail In (Except Aquatics)

Mail registration to:

Recreation and Community Services
P.O. Box 1988, M-23
Santa Ana, CA 92702
Attn: Classes

Mail-ins accepted anytime.

Walk-In (except Tiny Tots)

Jerome, El Salvador, Memorial Centers,
Recreation and Community Services
Transit Towers, 3rd Floor
405 W. 5th Street
Santa Ana, CA 92701

8:00am to 5:00pm.

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 |
=======|===============|========================|===============|=====|=====
                                                                      |
                                                            Total Fee:|_____

Check # __________

Release and Waiver of Liability

I consent to the above-named person participating in these activities and agree on behalf of thatperson that the undersigned assumes any risk for accident or injuries, from whatever cause in conjunction therewith, and release the City of Santa Ana, the Santa Ana Unified School District and the Rancho Santiago Community College District and their officers, agents and employees from any and all liability for any such accident or injury.

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)

Home | Help | Site Map
Add event | Advertise | Comment on event or location