Park Pals Enrollment Form (English)
The service being provided to you is funded by the U.S. Department of Housing and Urban Development (HUD). HUD requires the City to collect information on the income and ethnicity of program participants. The information being requested will be kept securely and will not be made available to the public. Thank you for your cooperation.
Email address *
Name Student *
Address *
City *
Zip Code *
Name of Mom or Guardian 1 *
Contact of Mom/Guardian 1 (Example: 916-555-1234, NA if not applicable *
Name of Dad or Guardian 2 *
Contact of Dad/Guardian 2 (Example: 916-555-1234, NA if not applicable *
Emergency Contact Name and Cell Number (If different than above.) *
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