The Historic Perth
  • The Historic City of Perth Amboy
  • The Historic City of Perth Amboy
  • The Historic City of Perth Amboy
  • The Historic City of Perth Amboy
  • The Historic City of Perth Amboy
  • The Historic City of Perth Amboy
  • The Historic City of Perth Amboy
  • The Historic City of Perth Amboy
  • The Historic City of Perth Amboy
  • The Historic City of Perth Amboy
  • The Historic City of Perth Amboy
  • The Historic City of Perth Amboy
  • The Historic City of Perth Amboy
  • The Historic City of Perth Amboy
  • The Historic City of Perth Amboy
 
A Message From Our Mayor

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Home > Recreation Registration
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CITY OF PERTH AMBOY
Office of Recreation

Registration Form
Child's NameDate of BirthAgeSexFee Paid (if applicable)
Money Order #:
Money Order #:: Make money orders payable to: City of Perth Amboy, Mail payment or Visit Office
Amount Due
Parent's Name:Choose Phone
Address:Phone 1
City:Choose Phone
State:Phone 2
Zip CodeEmail:
How did you hear about
the program?
 
EMERGENCY CONTACT: (Must be filled in or child will not be permitted to participate)
Name:Relationship
Address:Choose Phone
City:Phone 1:
State:Choose Phone
Zip CodePhone 2:
Medication
Does child have seizures?

Do you have any additional comments that would help us get to know your child?
 
HOLD HARMLESS AGREEMENT:

 
Parent/Guardian Signature: :: Please Print Your Name and Last Name as a Signature