East Brunswick Recreation & Parks

EAST BRUNSWICK RECREATION & PARKS

Household Information Form
The online registration system provides our participants with an additional method of registering for most Recreation programs. Individuals can register for a class, view household history, and pay a balance, 24 hours a day. In order to use this system, first time registrants must submit this completed form to the Department of Recreation and Parks, along with proof of residency for all adults (valid driver's license or current lease/mortgage with a photo ID) and proof of age (birth certificate or passport) for all children.

Once we have received your completed form and proofs, we will send you an email confirming receipt and provide you with a username and password so that you may access our online registration system.

If all information on the form is not completed and the necessary proofs are not included, your form will not be accepted.
Parent/Guardian Information:
Primary Parent/Guardian Name: *

First Name Last Name
Primary Parent/Guardian Address: *

Street Address

Street Address Line 2

City State

Zip
Primary Parent/Guardian Home Phone:
Primary Parent/Guardian Cell Phone: *
Primary Parent/Guardian Email Address: *
example@example.com
Primary Parent/Guardian Date of Birth: *

Month Day Year
Date
Primary Parent/Guardian Gender: *

MALE FEMALE Other
Secondary Parent/Guardian Name:

First Name Last Name
Secondary Parent/Guardian Address:

Street Address

Street Address Line 2

City State

Zip
Secondary Parent/Guardian Home Phone:
Secondary Parent/Guardian Cell Phone:
Secondary Parent/Guardian Email Address:
example@example.com
Secondary Parent/Guardian Date of Birth:

Month Day Year
Date
Secondary Parent/Guardian Gender: *

MALE FEMALE Other
Additional Household Family Members

Please include ALL family members living in your household
MEMBER #1
Additional Family Member 1 Name:

First Name Last Name
Additional Family Member 1 Gender: *

MALE FEMALE Other
Additional Family Member 1 Date of Birth:

Month Day Year
Date
Additional Family Member 1 Grade:
If NONE, please write NONE.
Additional Family Member 1 Email Address:
example@example.com
Additional Family Member 1 Cell Phone:
MEMBER #2:
Additional Family Member 2 Name:

First Name Last Name
Additional Family Member 2 Gender:

MALE FEMALE Other
Additional Family Member 2 Date of Birth:

Month Day Year
Date
Additional Family Member 2 Grade:
If NONE, please write NONE.
Additional Family Member 2 Email Address:
example@example.com
Additional Family Member 2 Cell Phone:
MEMBER #3:
Additional Family Member 3 Name:

First Name Last Name
Additional Family Member 3 Gender:

MALE FEMALE Other
Additional Family Member 3 Date of Birth:

Month Day Year
Date
Additional Family Member 3 Grade:
If NONE, please write NONE.
Additional Family Member 3 Email Address:
example@example.com
Additional Family Member 3 Cell Phone:
MEMBER #4:
Additional Family Member 4 Name:

First Name Last Name
Additional Family Member 4 Gender:

MALE FEMALE Other
Additional Family Member 4 Date of Birth:

Month Day Year
Date
Additional Family Member 4 Grade:
If NONE, please write NONE.
Additional Family Member 4 Email Address:
example@example.com
Additional Family Member 4 Cell Phone:
Parent/Guardian Signature: *

Clear
Date: *

Month Day Year
Date
PROOFS

Please submit the required proofs below. Selfies DO NOT count as valid proofs.
Parent/Guardian Acceptable Proofs:
- Valid Driver's License
- Updated Address Letter from the DMV with Photo ID
- Current Lease/Mortgage with Photo ID
Additional Family Member Acceptable Proofs:
- Birth Certificate
- Passport
- Valid Driver's License (if over 18)
If these proofs are not included you form WILL NOT be accepted.
Primary Parent/Guardian Proof of Address: *
Secondary Parent/Guardian Proof:
Additional Family Member 1 Proof:
Additional Family Member 2 Proof:
Additional Family Member 3 Proof:
Additional Family Member 4 Proof:
Should be Empty:

Parent/Guardian Information:

Additional Household Family Members

MEMBER #1

MEMBER #2:

MEMBER #3:

MEMBER #4:

PROOFS