Smart PDF Form

Family Information Form
Are you new to the Park Ridge Park District? In order to register, a current
Family Information Form must be completed to establish your family account.
Please complete ALL OF THE INFORMATION below and submit this form for processing.

When establishing a new resident household account, proof of residency is required.
Acceptable forms of proof of residency are as follows:
- Valid driver's license or state ID
- Current utility bill (within the last 30 days)
NOTE: When sending your documentation via email, we ask that you secure your account or license numbers by redacting/crossing out completely prior to submitting.

Resident rates apply to addresses within the geographical boundaries of the Park Ridge Park District. Please check your itemized property tax bill to verify that you pay taxes to the Park Ridge Park District. Your residency verification is valid for two years from the date of submission.
Please attach proof of residency (valid driver's license or state ID, or current utility bill within the last 30 days)

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Primary Contact for Family
Family Last Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone*
Primary E-mail*
example@example.com
(The Park District will keep your e-mail address confidential. This information may be used for updates & marketing promotions from the District.)
Family Members at Above Address

(Please check box if any Americans with Disabilities accommodations are needed.)
Family Definition: A family is parent(s), civil union partners, or legal guardians with unmarried children age 25 and under living at home. Children age 26 and older living at home and any other relative or individual may not be included on the family account. This includes nannies, grandparents, aunts, uncles, etc. They are considered individual residents and must be entered as an individual family account.

	Last Name	First Name	Birth Date	Phone Number	Gender	ADA Accommodation Needed?	Relationship to Primary
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2
3
4
5
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Emergency Contact Information

(Alternate to primary contact)
Full Name

First NameLast Name
Relationship
Home
Work
Cell
Should be Empty:

Family Information Form

Primary Contact for Family

Family Members at Above Address

Emergency Contact Information