West Melbourne, FL - Official Website

Recreation Class Registration Form

1. Student Information This section is complete This section is incomplete
2. Parent/Guardian Information (if applicable) This section is complete This section is incomplete
3. Emergency Contact Information (not a parent) This section is complete This section is incomplete
4. Activities This section is complete This section is incomplete

Please complete the online form below to register for classes.
If you would like to contact us by phone, you may call (321) 837-7779. Payment can be made by check, credit card or cash at the Veterans Memorial Complex.
First Name*
Last Name*
Date of Birth*
Date of Birth
Gender*
1. Male
2. Female
Age at time of registration*
Address1*
Address2
City*
State*
Zip*
Home Phone Number
ex: 555-555-5555
Primary Email Contact
Cell Phone Number
ex: 555-555-5555
Allergies / Medical Conditions*
Continue

Please tell us what class(es) you are registering for. You may also ask questions or make comments here.
Parent Signature

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