Please make (non-refundable) checks payable to Warwick Recreation Department. No cash payments will be accepted. Print this form and mail it with your check to the address below. Any returned check will require an additional $15.00 charge.
| Participants Name | Age | Class/Program | Time |
Fee |
| TOTAL DUE | ____________ |
|||
Payer's Name (please print): ______________________________________________________________
Address: ________________________________________________________________________________
City: ________________________ State:__________
Zip Code:_____________
Phone Numbers: Home:_______________ Work:__________________
Cell:_______________________
E-mail:__________________________________________________________________________________
Program Waiver: In consideration of this application being accepted, I hereby for myself, my heirs, executors and administrators waive any and all rights and claims for injuries or damages I may have against the program directors and the City of Warwick for any and all injuries I may sustain during said program.
Signature ____________________________________________________
Date _________________________________________________________
Buttonwoods Community
Center
3027 West Shore Road
Warwick, RI 02886