Type in the information, print, then
mail to West Shore Rec. A confirmation will be sent if an e-mail address is provided.
Notes:
- Birth date and gender are required to process the registration.
- Please provide the information of the person who is paying as well (name,
address, telephone, birth date, gender, municipality, etc.). Credit card
mailing address must match payer's address.
West Shore Rec Registration Form
(same family)
Address
City Zip Code
Township or Borough
Home Phone Daytime Phone
Cell Phone
E-mail Address
Birth date
Male or Female
2nd Person's
Birthdate Male or Female
Parent / Guardian (if enrollee is under 18)
Payer's Name
Payer's Address
(if different)
City Zip Code
Township or Borough
Home Phone Daytime Phone
Cell Phone
E-mail Address
Birth date
Male or Female
Credit Card #
Exp. Date Signature
West Shore Rec
704 Lisburn Road, Suite 101
Camp Hill, PA 17011
717-920-9515
