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

• Video Pizza, Monday, Dec. 5, Cost $8.00 - Course #: 92230
• CSUS Lady Hornets vs Fresno Pacific Basketball, Thurs. Dec. 4, 2012 - Course #:92324
• Holiday Crafts, Saturday Dec. 17, Cost $18.00 - Course#:92236
• Lunch & Cinema, Saturday, Nov 12 – 10:45am – 3:00pm, $8.00 Courst#: 92225
• Lunch & Cinema, Saturday, Dec 03 – 10:45am – 2:45pm, $8.00 Courst#: 92226
• Thanksgiving Dinner & Dance, Saturday, November 19, 2011, $5.00
  Registration Course #: 92239 / Just to make a donation, use Course #: 96523
• Evening Social, Monday, Dec 12 – 6-8:30pm, $8.00 Courst#: 92234
  

Form: Important: Not submittable online, please print-out after filled.
Hit "Refresh" after printing if working on shared computer.

*Enter Event Name and Course Number from above Event Information List

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: ___________

Mailing Address:

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

• Registration Policites and Information Web page open in new window
• Registration Policies and information open in new window (PDF) 119 KB
  Important: Registration Policies have changed. Please read Registration Policies before registering.
• Fillable PDF forms (Sept. & October PDF Versions of Calendar)
  open in new window

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