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2. Parent or Legal Guardian Information

4. First Name*
5. Middle Name
6. Last Name*
8. Street Address*
10. City*
11. State*
12. Zip Code*
14. Cell Phone
16. Email Address*
17. Other Emergency Contact (Name-Number)*
19. City of Ionia: Do You Reside Within the City Limits?*

    1. Yes

    1. No
21. Township: Specify, If You Answered NO to Previous Question
    -- Select One --Berlin TownshipEaston TownshipIonia TownshipOrange TownshipOther
23. Would You Like to Coach?

    1. Yes

    1. No

25. Participant Information

    You may enter up to three participants with this registration form. Information must be completely entered for each participant.

27. How Many Participants?

    1. One

    1. Two

    1. Three
29. First Name
30. Last Name
31. Birthdate
    Birthdate
33. Age
34. Enter $ Fee From Program Flyer
35. Special Request: Coach? Friend(s)?
37. Shirt Size
    -- Select One --Youth Small (6-8)Youth Medium (10-12)Youth Large (14-16)Adult SmallAdult MediumAdult LargeAdult Extra Large
38. School Grade in Fall
    -- Select One --3rd Grade4th Grade5th Grade6th Grade
40. First Name
41. Last Name
42. Birthdate
    Birthdate
44. Age
45. Enter $ Fee From Program Flyer
46. Special Request: Coach? Friend(s)?
48. Shirt Size
    -- Select One --Youth Small (6-8)Youth Medium (10-12)Youth Large (14-16)Adult SmallAdult MediumAdult LargeAdult Extra Large
49. School Grade in Fall
    -- Select One --3rd Grade4th Grade5th Grade6th Grade
51. First Name
52. Last Name
53. Birthdate
    Birthdate
55. Age
56. Enter $ Fee From Program Flyer
57. Special Request: Coach? Friend(s)?
59. Shirt Size
    -- Select One --Youth Small (6-8)Youth Medium (10-12)Youth Large (14-16)Adult SmallAdult MediumAdult LargeAdult Extra Large
60. School Grade in Fall
    -- Select One --3rd Grade4th Grade5th Grade6th Grade

62. Waiver of Liability

64. In consideration of the furtherance of your purposes, objectives and work and in consideration of your permitting me, my child, ward or heir to participate in any program (s) or event (s) pertaining to the City of Ionia, Department of Parks and Recreation or the Ionia School District., I the undersigned, or if under 18 my parent or guardian, INTEND TO BE LEGALLY BOUNDED HEREBY WAIVE AND RELEASE ANY AND ALL RIGHTS AND CLAIMS FOR DAMAGES WHETHER BASED UPON NEGLIGENCE OR ANY OTHER THEORY OF LAW, which I, my child, ward, or heir and our parents, guardians, heirs, executors, representatives, administrators, and assigns may have against The City of Ionia, department of Parks and Recreation, the Ionia School District., any affiliates or subsidiaries, officers, directors, shareholders, agents, employees associated with said corporations and associations, the municipalities or counties in or through which the programs or events take place or are conducted, as well as any other person, entity or sponsor connected with such programs or events, and their heirs, executors, representatives, administrators, successors, assigns, affiliates, officers, subsidiaries, directors, shareholders, employees or agents, FOR ANY AND ALL INJURIES INCLUDING DISABILITATING INJURY AND / OR DEATH OR DAMAGES WHICH I, MY CHILD, WARD OR HEIR MAY SUFFER while taking part in such programs or events as a result thereof.

66. Do you agree to the Waiver of Liability?*

    1. Yes

    1. No

68. Program Registration Online Payment

    $50 city resident (resides inside city limits) / $60 non-resident 

70. By submitting this form, you are agreeing to pay the registration fee online. If you do NOT have a receipt of payment, you WILL BE DROPPED from the enrollment of this activity.

72. Do you agree to pay online?*

    1. Yes
    2. No

74. If you click "yes," you will see a new screen to enter your credit card information and complete the transaction. 

    If you click "no," you have 48 hours to make payment by cash or check to the City of Ionia Parks and Recreation or City Hall. 

Leave This Blank:


76. 1. Receive an email copy of this form.
77. Email address

    This field is not part of the form submission.

78. Submit

* indicates a required field