Fax/Mail Registration
How to Register: Pre-registration is required. Walk-in or Mail to 2197 Chase Drive, Rancho Cordova CA 95670 Phone (master card/visa only) 362-1841 * Fax (master card/visa only) 362-9602 * Online (master card/visa only) www.cprd.com. Make checks payable to Cordova Recreation & Park District. Participant, (or parent/guardian, if participant is under 18 years of age) must sign a Waiver of Liability at first class meeting.
Participant Name: __________________________________________ Date of Birth: ____________________
Parent/Guardian Name: ______________________________________ Home Phone: ____________________
Address: ____________________________________________ Work Phone: _____________________
City: ________________________ State: ____ Zip: __________ E-mail: __________________________
Name of Class: Dates: Time: Fee:
______________________________ _________________________ ______________ $ _______
______________________________ _________________________ ______________ $ _______
Would you like to make a one-dollar ($1) or more donation to CRPD's Children's Funding Assistance Program? $ _______
Total $ _______
Credit Card #: ______________________________________ Exp Date: ____________
Print Name for Credit Card: ____________________________ Signature for Credit Card: ___________________
This is not a program of the San Juan Unified School District and SJUSD accepts no liability or responsibility.
SCUSD and FCUSD is not a sponsor, endorser, or otherwise associated with the above.
