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R A L E I G H P A R K S, R E C R E A T I O N A N D C U L T U R A L R E S O U R C E S

Main Contact Name_______________________________________ Youth Name_ _________________________________________

City of Raleigh Resident?

a

Yes

a

No

My Child Attends: (Select one.)

a

Traditional School Calendar – School Name: ____________________________________________________________________

a

Year-Round School Calendar – School Name and Track #: _ ______________________________________________________

a

Modified School Calendar – School Name: _ ___________________________________________________________________

a

Home School

You may select the following package programs and indicate a location selected (check all programs that apply):

Before School X-Press

a

$740 (resident)

a

$920 (nonresident)

Program Location (see page 6)_ __________________________________________________________________________________

After School X-Press

a

$1,460 (resident)

a

$1,640 (nonresident)

Program Location (see page 7) ___________________________________________________________________________________

Track Out X-Press

*

a

$1,620 (resident)

a

$1,800 (nonresident)

a

Weekly registration* (must complete next page)

Program Location (see page 8) ___________________________________________________________________________________

Friendly Track Out

*

a

$160 per week.

Available Track 4, Breaks 2, 3 and 4.

a

Weekly registration* only

(must complete next page). Available Track 4, Breaks 2, 3 and 4.

Program Location (see page 9)_ ____________________________ Dates:_______________________________________________

* If you prefer to select only specific weeks of Track Out programming, please complete Track Out Weekly Registration section (Page 15).

a

Y.E.S. Days

(Must be paid at the time of registration.)

Program Location (see page 10) ________________________

Days x $25 (resident) or $40 (nonresident) $_________________ Dates:________________________________________________

a

Friendly Y.E.S. Days

(Must be paid at the time of registration.)

Program Location: Jaycee Community Center

Days x $25 $_ ____________________________________________ Dates:________________________________________________

a

Weather-Bound

Program Location (see page 11)_ _____________________________________________________

a

Nonrefundable processing fee: $25.00

(Not applicable for Y.E.S days or Weatherbound)

Total Cost $

____________________

_

Continued next page

2016-2017 Registration

Program Selection

Please complete a separate registration for each child.

Program dates are subject to change. Please call 919-996-4800 for more information.

14

OFFICE USE ONLY:

Deposit $_ ____________ Site____________________ Receipt#_____________ Staff Name_________________________ Start Date_____________