2. Saturday, April 29, 2023
   

   North Clinton Recreation Center
   454 North Clinton Avenue
   12:00PM - 3:00PM

   Reed Gusciora, Mayor
   Department of Recreation, Natural Resources, & Culture
   Maria Richardson, Director

   REGISTRATION FORM

4. Participant Name*
5. Participant Name*
6. Participant Name*
8. Parent/Guardian*
9. Address*
10. State*
11. Zip Code*
13. Cell Phone#*
14. Email Address*
16. I hereby give permission to the City of Trenton to use any image depicting myself or my child(ren) named above for websites or other publicity purposes. This consent will apply throughout New Jersey and be for an indefinite period. Please initial below in the appropriate box:*
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18. Sign Here: *
19. Date: *

21. Khadijah Mcqueen
    Program Development Specialist
    (609) 508-2744

    
    

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