Full Home Address - *Swim team members who are out of district will receive SV School District rates. *
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Location (using the image above- inside the red outline only=Leesport Borough) *
Membership Type-Family- Includes 2 adults and up to 4 dependent children under 17 within the household, unless a full time student under 22.
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Membership Type-Family-
*additional immediate family members in your household- dependents under 18/ full time students under 22.
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Membership Type- Couple (2 adults from 1 household)
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Membership Type- Individual Child (< 18 )
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Membership Type- Individual Adult (18 < )
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Membership Type- Senior (60+)
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Names of Adult Member(s) (18+)
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Child/Teen Member(s) Names & Ages
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Sitter- Name (must register as an individual adult)
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Babysat Children- Name (must register as individual children & not included with family unit)
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# of Members Total
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If sending a check made Payable to Leesport Recreation, please mail it to PO Box 77, Leesport, PA 1-9-5-3-3.
When you submit the form, do NOT enter any credit card information if paying by check*If paying by credit card, please tap the link after submitting form. There is a small fee for credit card usage.