Please complete the following information about your household (A new household is defined as someone who has not previously registered for a program or beach pass with the parks and recreation department)

Password (up to 50 chars)
Retype to Confirm
Head of Household Information
Name of Primary Guardian (First)
Name of Primary Guardian (Last)
Gender
Date of Birth (mm/dd/yyyy)
School Grade
or highest grade
completed highest grade completed
Secondary Guardian Information
Name of Secondary Guardian (First)
Name of Primary Guardian (Last)
Gender
Date of Birth (mm/dd/yyyy)
School Grade
or highest grade
completed highest grade completed
Email and Phone Information
Primary EMail Address
Retype to Confirm Email Address
Home Phone w/ area code (xxx)xxx-xxxx
Cell Phone w/ area code (xxx)xxx-xxxx
Work Phone w/ area code (xxx)xxx-xxxx
Work Extension
Address Information
Mailing Address
Street Address if different
City
State
Postal/Zip Code
Country
Emergency Contact Information
Name of Emergency Contact (First) Name of Emergency Contact (Last) Contact Phone w/ area code Relationship

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