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, $8.00 Courst#: 92234
Form:Important: Not submittable online, please print-out after filled.
Hit "Refresh" after printing if working on shared computer.
*Enter Event Name and Course Number from above Event Information List
Participant's Name
Male
Female Age
Address
CityZip
Phone NumberEmergency Ph. Number
Special Information: Liability Release: I agree to hold the City of Sacramento, their directors, employees and committeemen harmless of any nature whatsoever for accident or injury to participants/myself arising out of or in any way connected with participation in city programs. I agree to give my consent to any medical treatment deemed necessary by a doctor.
SIGNATURE____________________________________ Date Signed
Office Use Only: Amt Pd:$ __________ 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