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PLC:

a005nm

Agency:

city of sisseton

For:

recreation registration

Phone:

605-698-3391

Address:

406 2nd avenue west
sisseton, south dakota 57262

*Required Field

Payment Information

*Child Name:

Middle:

*Last:

*Gender of Child:

Male

Female

*Age of Child:

*Child Current Grade:

*Child Date of Birth:

(Month / Day / Year)

*Child School attending:

*Parent or Guardian of Child:

Middle:

*Last:

*Address:

*City:

*State:

*Zip:

*Home Phone:

(### - ### - ####)

*Cell Phone:

(### - ### - ####)

*Email Address:

Work Phone (if any):

(### - ### - ####)

Any additional information:

*Alternate Contact Person:

*Contact Person Phone Number:

(### - ### - ####)

*Please Mark the activities that the Child will be participating in:

Art in the Park Ages 5-11 ($30)

Boys and Girls T-Ball Age 5 ($35)

Boys and Girls T-Ball Age 6 ($35)

Kindergym Gymnastics Completed K-1st Grade ($45)

Gymnastics Completed 2nd-7th Grade ($55)

Boys Baseball Age 7-8 ($60)

Boys Baseball Age 9-10 ($60)

Boys Baseball Age 11-12 ($60)

Girls Coach-Pitch Softball Age 7-8 ($50)

Girls Fast-Pitch Softball Age 9-10 ($50)

Girls Fast-Pitch Softball Age 11-12 (50)

Child's Shirt Size (Baseball and Softball only):

*Child's Hat Size ( Baseball only):

All activities involve a certain amount of risk. The City of Sisseton, Recreation Board/Employees, & the Sisseton School District will not be held responsible for any injuries or COVID related illness that occur while participating in the above activities

Please keep your children home from activities if they are sick. NOTE - REGISTRATION FEES ARE NON-REFUNDABLE

*As the Parent/Guardian of the above-named child, I understand and agree to these terms listed above.:

I agree

*Photo Permission: Will you permit the Sisseton Summer Recreation Program to use photos of your child for program promotion, social media, or community publications?:

Yes

Behavior Expectations: Children must listen to coaches/helpers, use appropriate language, and keep hands and feet to themselves. If a child needs to be corrected more than once, a phone call will be made home.

Continued behavior concerns will result in removal from the program.

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Payment Amount

Payment Amount :

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Subtotal:

$0.00

Service Fee:

$0.00

Total:

$0.00

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Billing Information

*First Name:

Middle Initial:

*Last Name:

*Billing Address:

*City:

*State/Province:

*Zip:

*Country:

*Phone Number:

*Credit/Debit Card:

(enter the full card number without any dashes or spaces)

*Expiration Date:

*Card Security Number: