RINGWOOD RECREATION SKATEPARK REGISTRATION FORM

I HAVE READ THE RULES AND REGULATIONS OF THE RINGWOOD SKATEPARK FACILITY AND WILL ABIDE BY THESE RULES AND REGULATIONS.

(please print)

NAME: ____________________________________________________

ADDRESS: _________________________________________________

TOWN: ____________________________________________________

STATE: __________________________  Zip: ______________________

DATE OF BIRTH: ____________________________________________

HOME PHONE: ______________________________________________

EMERGENCY CONTACT: _____________________________________

EMERGENCY PHONE NUMBER: _______________________________

SIGNATURE: ________________________________________________

I WILL KEEP A COPY OF THIS REGISTRATION FORM WITH ME AT ALL TIMES WHILE AT THE SKATEPARK FACILITY.

Mail a copy of this form to:

Ringwood Recreation - 60 Margaret King Avenue - Ringwood, N.J.  07456

(Your registration will not be valid until received in the Recreation Department)