Wildwood Park District Registration Form (Print This Form to Mail, Fax or Bring In)

Fax (847) 223-2820    Phone (847) 223-7275

Use this registration form for mail-in or faxed registration.  Fill out the form by signing the waiver and indicating name, address, phone number and program desired.  Enclose a check or enter credit card information and mail to:  Wildwood Park District, 33325 Sears Blvd., Wildwood IL  60030.  You may also print and fax this form to our office at (847) 223-2820.  In-person registration is also accepted at the park district office located in Rule Park, 33325 Sears Blvd. Wildwood.  You will be notified if, for any reason, we are unable to complete your registration.  If you do not hear from us, your registration has been processed.  We do not send written confirmations.

Office Hours:  Mon, Tues, Wed, Fri  9:00am to 2:00pm, Thurs, 9:00am to 7:00pm

REFUND POLICY - Requests for refunds from any program must be made no later than 5 working days prior to the first class.  Refunds will be sent in approximately 2 weeks from the date of the request.  Please note that there is a 20% (maximum $10) processing fee on all refunds.  However, if a class is cancelled due to insufficient registration, participants will be notified and the entire fee returned.  No refunds will be issued once a class has started without a written medical excuse.  There is a $5 fee to switch sessions will apply to all changes without a written medical excuse.  

RESIDENCY - All those living within the park district limits of Wildwood (except Royal Oaks) and includes Wildwood 2 and Country Faire.  All those living outside Wildwood and residents of Royal Oak Apartments are considered non-residents and the NR fee applies.

WAIVER AND RELEASE OF ALL CLAIMS -   As a participant, I acknowledge that there are certain risks of physical injury and I agree to assume the full risk of any injuries, including death, damages or loss which I may sustain as a result of participating in any and all activities connected with or associated with such program.  I assume full responsibility to inform the instructor of any physical/medical condition that may affect participation.  I agree to and relinquish all claims AI may have against the Wildwood Park District and its officers, agents, servants and employees as a result of participating in the program.  I do hereby fully release and discharge the park district and its officers, agents, servants and employees from any and all claims from injuries, including death, damage or loss which I may have as a result of my participation in the program.  I have read and fully understand the above waiver and release all claims.

__________________________________________________________________________                     _____________________

Signature of participant or parent of minor age participant                                                                               Date

Emergency Contact__________________________________________________________________________

Please list special accommodations you may need for participation_______________________________________________________

Adult/Guardian Name (Last/First_______________________________________     Home Phone___________________  Work Phone__________________

Address_________________________________  City_________________________  State___________    Zip___________________

Participant Name                        Age DOB          Sex             Class Name                                            Class #               Start Date     Day              Time                      Fee

  _______Cash     _______Check    _______Visa  _______MasterCard     ________Discover        Total Paid        $_____________

__________________________________________        _______________________            ____________________________________________

Credit Card Number                                                                Expiration Date                                 Cardholder Signature           

 For Office Use : Ck #_____________   Date Rcvd._____________  Rcvd By______________   Total$_______________