Issue 65 - Heights Highlights Spring 2004Activity Name
2.
3.
Activity Date
Fee
Please fill in this section for Youth Programs Only:
School Grade - Child's Age
Male Female _
_ Birth date —/—/—
Participants Name
Home Phone (Youth Only) Parents cell or work phone
Address
City
Zip
Participant signature (or Parent signature if participant is under 18) Date
(Seniors Only) NIN U CARE #