Takes Place At: The Brownson House
Start Date: Information up coming
End Date: Information up coming
Registration Fee: Information up coming
Admission Fees (per game): N/A
If you have any questions or would like more information please contact Jon Celani at 724 222-1440 or via email at firstname.lastname@example.org
You can register for any Brownson House Program in three different ways:
- Register in Person – Print out and bring in a completed registration form during registration period for the program you wish to participate in. If there are any applicable fees, please be sure to bring the appropriate amount with you.
- Register by Mail – Print out and mail in your completed registration form during the registration period for the program you wish to participate in. Be sure to include a check to cover the costs of the program you are registering for.
- Register Online – Please fill out the online form and submit. Then bring the payment with you to the game or mail it to: The Brownson House Inc. 1415 Jefferson Avenue Washington, PA 15301.
Registration Form Summer Session 2015
Name_____________________ Age________ Date of Birth____/____/____
Street Address_________________ City____________________ State/Zip_____
Phone Number (Home) ______________ Phone Number (Cell) ______________
Male ( ) Female ( ) Grade Youth K- 5 ( ) Middle School 6-8 ( ) High School 9-12 ( ) Collegiate/ Post-Collegiate ( )
Experience level: Beginner( ) 1-2 years ( )3-4 years ( ) 4 years+ ( )
I have listed (on the reverse of form) any known Medical Condition(s) and Physician-prescribed medication(s) of the above named player and attest the player is medically insured, and should player be injured, emergency medical treatment and any necessary transport to a medical facility is authorized.