1. health and fitness
2. addiction

How to Register
t
Registration Starts
Monday, August 19,2013
Non-City Rcidcna;
Monday, Augud 2e 2013
Vhlk-in: Zt3 Uttlc hllr $. lherc re no regisnation fom
to omplctc. Rcgistntion begiro ar 8m on dre 6rst dey of
*
Regilt t E.rly:
a
rqismtion.
basis.
on
Dadlirc to
to thc
ds. Esdy rtgictndon hdpc
lmntocdleeioo.
Scaior Crtirc Scnior Citias (55+) rciding
paymmt, md mail m Frlls Gu&Rcocuim ud Prdc
Dcprtmmt, 223 Litdc fll& SL &lls Chund! UA220l16
S
dsc rc filled
rqtrtc..l! tJ/I,ic.lyorc wc&prior
buinc &y.
*
All
6ntome, first-swcd
strrt of$c
pwd
at thc od of drc
Completc the regisrration form below, indude
Maft-iar Mail-in rcgistratioro uc
k
Fdls Church Ciry Residcna:
Go to w&llsc$urdm.gdrccrcrrtm md
di&on dre fglls Church Recmtion md Parls Depamcnt
logo. Full paymcnt is rcquircd rt rhc time ofrcgisrationRcgisnadon b€gis at 8m on thc 6nt day ofrcgisuation.
On-lirc
in the Gty of Fdls Church will rmivc a 50%
dircut on regisation fcc only. All supply or
mtcrial fec must bc paid in ftIl.
Phone in regisration begim 8am thc sond &y
of registntion Augut 20 md August 27. To rcgister, call
havc you cedit wd ready.
7Ot 2fi-frn
Phorc-in:
FiroijAt& Fimcial aid is available for
City of Falls Church rcidents only. Foms m
available in dre main ofrce or sll
^rd
7O3 ?'Q-5027 for morc infomation.
For Mor,e
lnformationr Call 703 24JB-5O27I Fax 703 536-8150
Mail to Falls Church Rccation nd Prls Deytnerr,z23l.itde Falls St Falls Chuch'VA22046
Makc chcdc payeble to City of Falls Chuch. Only one family per fom. Photmpic re aepted.
Paymot must aongany rcgisration' Iate regimtios ilc rePtcd if m opening is anilable'
Primary Hoq€hold
l-rrt ilare:
zip:
Crty:
€vd$ng Phde Numbs:
(
)
Day Ph6e Nwbcr:
(
)
udmd dt 6e my bc d& inficm iu rry dMry, induding @.iq rd I z.lodtL$c tltd I he
edviscd o st& 6c advir ofa nodkd daor bcforc I c ry child sricipare in thb prog@ I .nd E
dl ridc of illrr or inlury efting fru Pdrt<iPedof, h d! ProBroG) mtld bdm
<[iH ge to w
* o drc sf*y of Sb prcgm fu rc I
I undcduld dd *. Ctyof Fdh Cbud mlc m rtglwioro
-Cburh,
i6 F6' 06€' rd anflo1c. in<tudlrg tbc
ard ry drild bcr*v wtir .nd aas rlc Ciry of FAf
M; i"'@.;tqn.d sid ,ll diG 6r ilnd or iDiury ditEdy cul.nBfm ry p*dcipetbo in
I
ba
d|! progm
Particip.dt Sigmture:
C{fllMtlG \6u will be noti{i€d il thc cl6 ii ceGlled d 6il9cd.
with d8 infomation indudinq srt d.te, tire ild locatiotr
Your
r4ipt prdidd yo!
Crcdft Cerd lnfonnrtion:
circle
oe:
EIgE