Billerica Recreation Registration Form

Billerica Recreation REGISTRATION FORM

Mail it to: Recreation Dept
248 Boston Rd
Billerica, MA 01862

Print out this Form,
Complete and mail with your check
Make payable to "Billerica Recreation Dept."

This form is provided by S.A.F.E.

Questions?, call: Billerica Recreation (978) 671-0921

Participant's name (First)________________________(Last) ________________________

For multiple participants in one program add names below:

Participant #2 name (First)________________________(Last) ________________________

Street & # ____________________________________________________

City/Town ______________________________ State ________ Zip Code________________

Phone (evening)_______________________(day) ____________________ (cell) _________________

email address ___________________________________ {Registration is confirmed via Email}

Unless otherwise posted, classes are held at: Billerica Town Hall, 365 Boston Rd, Billerica MA 01862

Indicate desired program by placing a value in the Qty column and calculating the Extended Price.

I have read and understand the S.A.F.E Refund Policy, my check for the Total amount is enclosed.

Signature __________________________________________ Date: _______________