*Online Registration Form
with Event Titles, Cost, and Course Numbers:

Form: While filling out this form, use the information listed with your event in the list directly below.

• LUNCH & CINEMA, DOWNTOWN PLAZA, SAT, MAY 5, $ 8.00 - COURSE #: 108873
• VIDEO PIZZA, MON, MAY 7, $8.00 - COURSE #: 106021
• EVENING SOCIAL, MON, MAY 14, $ 8.00 - COURSE #: 106034
• CRAFTS DAY, SAT, MAY 19, $12.00 - COURSE #: 106029
• RIVERCATS GAME, TUE, MAY 29, $33.00 - COURSE #: 108877
  

Important:
Not submittable online, please SELECT (or highlight) form portion of page and choose "Print Selection" to print filled-in form.

Participant's Name

Male   Female     Age

Address

City Zip

Phone Number Emergency Ph. Number

Special Information:
Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.

SIGNATURE____________________________________ Date Signed

Office Use Only: Amt Pd:$ __________ Amt Due:___________
Ck or MO#:_________Cash  __  CC__ Rcpt #:_______Date: ___________

Alternative Form, Registration Information, and Policiies:
PDF Registration Form 82 KB Open in New Window
Registration Policies
Registration Policies (PDF) 119 KB Open in New Window

Mailing Address:
Coloma Community Center / Phil Sinclair, Access Leisure
4623 T Street, Sacramento, CA.  95819
Fax, Attn: Phil Sinclair, 916-454-3956
Make Checks Payable to: City of Sacramento

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