General Information
General Information
Summer Camp 2026	
Page 16	
www.concordparksandrec.com
Registration Form
Registration Form
For Office Use Only
For Office Use Only
RETURN WITH PAYMENT TO:
Concord Parks & Recreation Dept.
14 Canterbury Rd. 
Concord, NH 03301 
Make Checks Payable to: City of Concord
CONTACT US AT:
 Office:  225-8690
 Fax:     225-8589
 E-mail: recreation@concordnh.gov
 Web:  www.concordparksandrec.com
 Check #________    CC        Cash       Schlrshp
 Amount:_______________  Entered:________
Total Fees
Total 
Amount
Youth 
Scholarship Donation 
Rounding up your 
program fee helps provide 
financial 
assistance to those  
otherwise unable to afford 
the cost of a program.
PARENT/
GUARDIAN
CONTACT
INFO
Please Print
Adult First & Last Name
Address
City	
	
	
	
	
	
	
State	
	
	
	
	
Zip
Home Phone	
	
	
	
	
	
Work Phone	
	
	
	
Cell Phone
E-mail	
	
	
	
	
	
	
Emergency Contact Name		
	
Phone Number
REFUND PROCEDURE - Refunds are issued only 
when a class is cancelled by the Parks & Recreation 
Department or the participant enrolled in the program 
has a note from a physician’s office stating they are 
not able to participate in the program because of a 
medical condition. Refunds will not be issued if a class 
is cancelled due to inclement weather. If you feel your 
request for a refund was unfairly denied, there is an 
appeal process.  Appeals must be in writing and sent to 
the Concord Parks & Recreation Department.
PLEASE LIST PARTICIPANT INFORMATION AND THEIR COURSE CHOICES
Participant Information
First Name	
 Last Name
Date of 
Birth
Sex
Child's 
Elementary 
School
Child's
Grade  
in Sept.
Name of Class / Program
Class Code
Fee
3
Mail-In
Mail  completed registration 
form & payment to: 
Concord Parks & Recreation
14 Canterbury Rd., Concord, 
NH 03301
1
Fax
Fax your registration 
to:(603)225-8589 and contact 
us at 603-225-8690 with  
payment information
4
In-Person/Walk-In
Visit us in at the Parks & 
Recreation Office at 14 
Canterbury Rd.. to fill out your 
registration in person.   Office 
hours are 8 a.m. - 6:00 p.m.
REMEMBER THESE 4 EASY WAYS TO REGISTER!
On-Line 
www.concordparksandrec.com
Customers can sign-up via our 
on-line registration system at 
www.concordparksandrec.com
2
List any special needs or medical conditions we should know about  
****PLEASE READ AND SIGN THE WAIVER BELOW****
In Consideration for me and/or or my child/ward to participate in the sports and other activities of the City of 
Concord, New Hampshire Park and Recreation Department, we HEREBY WAIVE AND RELEASE the City of 
Concord, its officers, employees, agents and volunteers, individually or in an official capacity for the City (all for 
purposes herein also referred to as “Releasee”) from all liabilities, claims, actions, damages, costs or expenses 
which we may have against any of the Releasee arising out of or in any way connected to participation in the 
activity, including, travel to or from the activity, for bodily injury, death or property damage suffered by me/my 
child/ward before, during, or after said activity.  In addition, I give my permission for the child(ren) to be treated 
by qualified medical personnel in the event that the parent/guardian named below cannot be reached at the 
phone numbers provided. 
I understand and agree that all Parks & Recreation Department classes/events may be photographed.  I give 
permission to Parks and Recreation Department to use participants' photo for display or advertisement by the 
City of Concord, Parks & Recreation Department.
 
                          	
                                        
 Signature (parent/guardian if participant is     
 under 18 years of age
 Date

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