Registration Form

Please use one registration form per participant.

For multiple participants, you can simply click the back arrow after you submit the form and edit the name.
You will be directed to a paying online option or you can mail or drop your payment off at:

Nisswa City Hall P.O Box 410 Nisswa, MN 56468
Questions? Email or call Matthew Hill 218-963-0047.

Student First Name*

Last Name*

Birthdate *

Age *

Parents' Name (s) (If applicable):

Email address*

Home Phone *

Cell Phone *

Work Phone

Address*

City *

Zip *

Shirt Size *

Late Registrations will be accepted on a space available basis only.

Please list any medical conditions our staff or coaches should be aware of.

I undersigned, parent or guardian or participant, do hereby agree to allow the individual named to participate in Nisswa Parks & Recreation recreational activities with the understanding that it is voluntary.

I further indemnify, and hold the City of Nisswa and its employees harmless from and against any liability for any injury which may be suffered by the aforementioned individual arising out of, or in any way connected with,

his/her participation in this activity. If I object to the use of my child’s photograph in any agency or non-agency publication, I will contact Nisswa Parks and Recreation Department directly.

Parent/Guardian Signature

Date

Class(es) you are registering for:

Youth Programs

Select Class:

Select Activity:

Fall Soccer - K-1st grade $50

Fall Soccer 2-4th grade $50

Flag Football $50

Comments

I am paying by:

Paying via Online payment system (you will be redirected after submitting form)