Hortonville Rec Registration 2024

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Singing up for the Summer Program

Email *

Name of Child(ren) (first & last names) *

Age(s) of Child(ren) *

Address (Street, City, State, and Zip) *

Full name of Child(ren)'s Primary Guardian *

Primary Guardian's Phone Number *

Full Name of Child(ren)'s Secondary Guardian *

Secondary Guardian's Phone Number *

Full name of Emergency Contact (someone other than the two already listed) *

Emergency Contact Phone Number *

I am a... *

Resident ($200)

Non-Resident ($275)

Payment Type that I will be choosing to pay *

Online payment (card or bank account)

In-person payment (cash, check, or card)

Check in the mail (Send to Village of Hortonville)

I am requesting an application for financial assistance from the Friends of Hortonville Library Fund.
*

Yes

In collaboration with the Friends of the Hortonville Library (FOHL), a fund is being established to offer financial assistance to any family who may be of need to enroll in Hortonville Recreation this summer. Are you interested in giving a financial donation to this fund?
*

Yes

Size(s) for my child(ren)'s t-shirt(s). If two shirts of the same size are needed, please add a second shirt in Other.

Kids small

Kids medium

Kids large

Adult extra-small

Adult small

Adult medium

Adult large

Adult extra-large

Other:

I understand that if I have not paid my child(ren) cannot come to Rec. *

I understand

I do not understand

I understand that I cannot get a refund if the program has already started. *

I understand

I do not understand

I would like to donate to the Hortonville Rec Program. Donations do not have to be only money. (But if money please say the amount below) Explain what you will be donating. Examples: pens, paper, markers, colored paper, crayons, colored pencils, pencils, board games, glue, etc. *

Does your child(ren) have any allergies? If yes please list below. If no then please say n/a *

I give consent to allow photos of my child(ren) to be used as promotion and to showcase the Hortonville Rec Program. *

I do give consent to allow photos being taken of my child(ren)

I do not give consent for allowing photos to be taken of my child(ren)

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