To register, print this page, complete the information below, and return it with payment to: Park and Recreation Department, West Goshen Township, 1025 Paoli Pike, West Chester, PA 19380.

Name:__________________________________ Phone:_____________________________

Address:___________________________________________________________________

__________________________________________________________________________

Session (Please circle one):   Winter   Spring

Payment ($50 for West Goshen residents; $60 for non-residents): ______

Medical Insurance Company:___________________________________________________

In case of Emergency, call (if different than home):____________________________________

I, the undersigned, intending to be legally bound for myself, my heirs, executors, administrators, and assigns, hereby waive and release any and all rights and claims for damages I may now or hereafter have against West Goshen Township and its respective employees for any and all damages or injuries which may be sustained by me or my family arising out of participation in the above activity.

_________________________________          ________________________________
 Signature*                                                                     Date

* Signature of parent or legal guardian if participant is under 18.

Make checks payable to "West Goshen Township." Sorry--we are unable to accept electronic payments.