West Shore Recreation Commission

Registration Form • ActiveNet
 

 

 

Registration Form

 

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Type in the information, print, then mail to West Shore Rec.
A confirmation will be sent if an e-mail address is provided.
Notes: Birth date and gender are required to process the registration.
Please provide the information of the person who is paying
as well (name, address, telephone, birth date, gender, municipality, etc.). Credit card mailing address must match payer's address.

West Shore Rec Registration Form

Activity  Fee
Section Letter
(if applicable)   Level
Time   Location
Starting Date
Participant Name
Additional Name
, if applicable
(same family)
Address
City   Zip Code
Township or Borough
Home Phone   Daytime Phone
Cell Phone
E-mail Address 
Birth date      Male or Female
2nd Person's Birthdate   Male or Female
Parent / Guardian
(if enrollee is under 18)

Payer's Name
Payer's Address
(if different from above)
City   Zip Code
Township or Borough
Home Phone   Daytime Phone
Cell Phone
E-mail Address 
Birth date      Male or Female

Credit Card #    CVV #

Exp. Date   Signature

West Shore Rec
507 Fishing Creek Road, P.O. Box 413
Lewisberry, PA  17339

717-920-9515