S.P.O.R.T. REGISTRATION 

WINTER SESSION

Please complete and return with check or money order (no cash) to:

Belmont Recreation Dept. PO Box 56 Belmont MA 02478

Name _____________________________________________DOB________Phone___________

Address __________________________________E-mail address _____________________

I hereby grant permission for myself/my child to participate in the Belmont S.P.O.R.T. program.

I expressly agree to release and save harmless the Town of Belmont or any of its employees

and volunteers from any liability for injury resulting from participation in this program.

Date Parent/Guardian Signature  ________________________________________

Please check each program for which you would like to enroled

Program                                                                             Date                                                 Cost/Check to Enroll

Swim Lessons/Beginner                                         1/10-3/28/09 12 noon                                         $45.___

Swim Lessons/Beginner                                         1/10-3/28/09 12:30 p.m.                                     $45.___

Swim Lessons/Interm                                             1/10-3/28/09 1p.m.                                              $45.___

Swim Lessons/Adv                                                 1/10-3/28/09 1:30 p.m.                                        $45.___

Dance Like a Star                                                     1/8-2/12/09                                                           $35.___

Water Aerobics                                                         1/6/08-2/12/09                                                     $40.___

Saturday Mini-Camp                                                 1/10-3/28/09                                                         $45.___

Time Out                                                                     1/10-3/28/09                                                         N/C___

Ice Skating                                                                 1/11-2/22/09                                                         $40.___

Nordic Skiing                                                             1/6-2/24/09                                                           $10.___

Music & Munchies                                                     3/5-4/9/09                                                             $35.___

Bowling                                                                      1/10-3/28/09                                                         $45.___

Alpine Skiing                                                             1/10-2/14/09                                                         $10.___

Friday Night Socials                                                 Winter Events                                                     $10.___

(if applicable)

Total Program Cost _______

Non Resident Fees ________

Total Enclosed _______

No winter program brochures will be sent. Please make copies as needed for additional registrations.

Thank you.