Department of Parks and Recreation

Ross Township Municipal Center
1000 Ross Municipal Drive, Pittsburgh, PA 15237
Phone: (412) 931-7041 or (412) 931-7055 x204

PROGRAM REGISTRATION FORM

Please fill out a separate registration form for each participant and program. Acceptance of registration form is based on availability and first-come, first-served basis, as some programs are limited in size.

Residency Status*
Select the Residency Status

Kindly Select the Residency Status to View the Programs & Payments.

Select Program Non-Resident*
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Select Program Resident*
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Program Date
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Program Season*
Select the required Season

Convenience fee

2.00 Convenience fee

Program Name
Please let us know your name.

Total Amount
0.00 USD

Participant's First Name *
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Participant's Last Name *
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Participant Email*
Please let us know your email address.

Participant's Birthdate*
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Age*
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Sex
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Parent/Guardian Name
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(If participant is under 18)

Phone (H) *
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(W/C)
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E-mail Address
Please let us know your email address.

May we contact you via e-mail?
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Street Address *
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City/State/Zip *
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Emergency Contact *
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Phone (H) *
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(W/C)
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Does participant have any medical concerns? If so, please list:
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Check here
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Basketball and Summer Camp only – T-shirt Size:
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Liability Waiver

I give my consent for the above named person to participate in this program sponsored by the Ross Township Department of Parks & Recreation. I will not hold Ross Township, the Parks & Recreation Department, the Department’s employees, coaches, volunteers, officials/umpires, other participants, or agents or employees of Ross Township responsible in the event of injury as a result of participation. I understand the risks involved and know the above named person is physically able to participate in the activity. I further state that I have carefully read the forgoing liability waiver and know the contents thereof, and I sign the same as my own free act. I acknowledge that signature by either parent or by one guardian hereby binds all parents and/or guardians of any minor participant.

Permission to Use Image

I grant Ross Township permission to use, for any legitimate reason, any photographs, motion picture, or recording of my participation in this activity

Participant's First Name*
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“Participant or Guardian if Participant is under 18 years of age”

Participant's Last Name*
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Date*
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*
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By checking this box and submitting this form electronically, I understand that I agree to the above terms as put forth in the School/Community Partnership and Liability Waiver sections.