Form Center

2. Today's Date
   Today's Date
4. Participant Name*
5. Middle intial
6. Last name*
8. Current address: Street/Apt*
9. City*
10. State*
11. Zip code*
13. Phone/Cell*
14. work phone
15. email address*
17. Gender*
    -- Select One --malefemalePrefer Not to Say
18. Age Today*
19. Grade level*
    -- Select One --Homeschool PreschoolKindergarten-2nd grade..N/A
21. Child's Date of Birth*
    Child's Date of Birth
22. Additional Child(ren)

    Please include each child's age. birth date, and grade level

24. Parent/Guardian Name*
25. May also be released to: *

    Must be at least 18 years old. 

27. Allergies/Health Problems, past or present*

    Type N/A if your child has no health issues. 

29. Emergency Contact Name*
30. Emergency Contact Number *
32. Emergency Contact Name
33. Emergency Contact Number
35. Activity *
    -- Select One --Itty Itty Bunnies (18mos - 3): 6-6:30pm/Senior Center - $100.00 FeeBizzy Bunnies (3-4 years old); 6:30-7pm/Senior Center - $100.00 FeeHappy Hoppers (5-7 years old); 7-7:30pm/Senior Center - $100.00 Fee

37. The registration fee for the first child is $100.00 and $80.00 for each additional child.

    The Romulus Recreation Department has been relocated to the Romulus Athletic Center (35765 Northline Rd)

    Please call (734) 941-8665 for more information.

41. Waiver, Release of Liability & Indemnity Agreement

    In consideration of my or my child’s acceptance of my or my child’s registration in the above program(s) do I hereby, for myself or my child, my heirs, executors and administrators, waive release and forever discharge any and all rights and claims for damages which I or my child may have or which hereafter accrue to me or my child against all municipalities special districts, and properties through which the program(s) will be held or its respective officers, instructors, administrators, successors, and/or assigns for any and all damages which may be sustained or suffered by me or my child in connection with my said participation in the above program(s). I further represent that I or my child are in good physical condition and have no disability or ailment that will prevent me or my child from engaging in the activity for which I am registered.

45. Our Photo Policy

    Enrollment in Parks and Recreation Department sponsored programs authorize Romulus Parks and Recreation, its departments, employees and contractors to take your or your child’s photograph for use in future brochures, flyers, documents, displays, and other publications, website and on social networking websites. Parks and Recreation will not sell, use or authorize others to use such photographs for commercial purposes

46. Please initial
50. Electronic Signature Agreement*

    I, the undersigned parent or legal guardian of the child shown below, have read the above Waiver, Release and Indemnity Agreement and agree to its terms on behalf of my child and myself.  I understand that by signing below, I am giving up substantial rights on behalf of my child and myself.

    1. I agree.
52. Electronic Signature
53. Date*
    Date
57. Disclaimer

    No class confirmations are mailed out. You will only be notified if your class is cancelled. Proper fees must be enclosed for valid registration. No class or program openings will be held or saved for persons registering without payment. Registrations are taken on a first come, first serve basis. Mail-in registrations must be received at least one (1) week prior to the beginning of class. Check or money order is accepted. Nominal fee will be charged for credit card use. Checks can be made out to the City of Romulus.

59. Pay Here

    City of Romulus MI (invoicecloud.com)

Leave This Blank:


61. Submit

* indicates a required field