Parks and Recreation

Child’s Name:(required)

Child’s date of birth:(required)

MaleFemale

Grade (entering the 2025 –2026 school year. Must be entering 7TH grade-9TH grade) (required)

Address: (required)

Your Telephone Number (required)

Your cell Number (required)

Emergency Contact:(required)

Emergency Contact Telephone Number (required):

Your Email (required)

I acknowledge that I have read and agree with all of the rules of the program and that the information provided above is accurate. I acknowledge that enrolling my child in the program you are assuming risks of medical expenses for my child that may be incurred due to any accidents.

Payment required first day of clinic, check or money order only payable to Village of Florida.