Registration BY MAIL
East Berlin Area Community Center
P.O. Box 530
405 North Avenue
East Berlin, Pa. 17316
717-259-8848

Registration IN PERSON
Monday thru Friday…. 8:00 am to 1:00 pm

Registration BY PHONE
Accepted if paid by registration deadline.

PROGRAM CANCELLATION
Activities may be cancelled due to inclement weather. Call your instructor OR the center for more info.

REFUND POLICY
No class refunds will be given after the registration deadline.

No refunds given for missed classes.
 
REGISTRATION FORM

Make checks payable to “EBACC”.

Name:_____________________________________________________________  
Address:___________________________________________________________
Home Phone:_________________________ Business Phone:__________________
Class Name:________________________________________________________
Date________________Time_______________Class Fee____________________

The East Berlin Area Community Center activity program and facilities are made available
and utilized on the basis of “use at your risk”. I hereby assume all possibilities of an accidental
injury at my own risk in connection with this program and realize that the East Berlin Borough and
the East Berlin Area Community Center DO NOT cover my participation in this program
with an accident insurance policy. In the event of an injury, unless negligence on the part
of the Borough or the Community Center, I realize that I must use my personal accident
insurance coverage, if I have such, for any type of claims involved. Otherwise any such expenses
shall be my responsibility.

Signature of Participant _________________________________________Date___________
         
Signature of Parent (If under 18)___________________________________Date__________