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If you are human, leave this field blank.GENERAL INFORMATIONFamily Name *Address *City *State *AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip Code *Home Cell *Cell Phone *Work PhoneEmail *Emergency Contact/Relationship *Emergency Contact Phone *Please indicate if you have any special needs or require any accommodationAre you a Lansing resident? *Proof of residency may be required.YesNoPAYMENT INFORMATIONName on Credit Card *Card Type *MasterCardVisaAmExCredit Card Number *Expiration Date *CVC *PROGRAM REGISTRATION INFORMATIONPlease refer to the program brochure at the right for details about each program. If the desired program isn't listed, please register in person.Participant 1 Name (P1) *P1 Gender *P1 Date of Birth *P1 Program Title *Choose One**Fitness**Butts and GutsCardio & Strength TrainingChair FitnessLose the Mat YogaPersonal TrainingPoundReady To RunSalsationSenior Beats!Senior Fitness PlusSenior SpinSilverSneakers Classic & Renew ActiveSpin & FitStep AerobicsStretch & BalanceTai ChiWater - Aqua ArthritisWater - Aqua Kick & BurnWater - Aqua Zumba/Body ScultpingWater - Water Aerobics *American Red Cross Swim Lessons*Swim Lessons - AdultSwim Lessons - PreschoolSwim Lessons - Teen & AdultSwim Lessons - YouthParent and Child Aquatics***Tiny Tots***2 & 3 School For MeAdult Tot BaseballAdult Tot SoccerBaby Book ClubColors and ShapesFirst Art Lil Dribblers Movin to MusicParent & Child AquaticsParent-Tot TumblePee Wee PlaygroupShake, Rattle, and RollSticky FingersTiny CelebrationsTots Open Gym***Early Childhood***Baking BuddiesBitty BasketballBookwormsCome and ClayDance It OutDoctor SchoolFall DaysGirls RockGo YogaHealthy KidsJunior ExplorersLearning LettersLittle AmigosLittle NinjasLittle Sluggers and KickersPaint LabSports & MoreTeddy Bear's Picnic - A Mother/Daughter EventTee Ball Basics***Youth***Bring Your RacquetCanine CuisineChalk The WalkCheckmate!Devilishly DeliciousFloor Hockey Skills & DrillsGo YogaIndoor Pickleball for KidsLearn To SewMicro Soccer U10Nerf WarsO' Christmas TreePlaying Recorder 1Playing Recorder 2Private Piano LessonsSand Volleyball Skills FundamentalsScout ArcheryStar Wars Cooking Softball BasicsTotal SportsYouth BadminitonWood Carving***Art***Action ArtDiscovering Great ArtistsLearning Art***Youth Basketball***D.A.Y.O.N.E. 1st and 2nd Grade BasketballD.A.Y.O.N.E. Skills TrainingD.A.Y.O.N.E. Youth Basketball LeagueD.A.Y.O.N.E. Skills & DrillsD.A.Y.O.N.E. Center Court***Music Classes***Private Piano Lessons ***Gymnastics***Boys GymnasticsGirls & Boys Advanced GymnasticsGirls GymnasticsPreschool Gymnastics***Karate***Kicking TotsPre-Teen Martial ArtsTeen Martial Arts***Teens***D.A.Y.O.N.E. Skills TrainingHorror - A Halloween MasterpieceLife Skills For TeenagersModern Cartooning - AnimeTeen/Adult ArcheryTeen & Adult Swim Lessons*Adults*ASL - Mom/Dad and me!ASL - Learn to SignAdult Beginner PickleballAdult CPR/AEDAdult & Senior Dance ClassesBasket WeavingBid WhistESL - English as a Second LanguageFirst AidMerriest ChristmasThe Grilled Cheese Murder*Seniors*Basket WeavingChristmas ScrabbleChair FitnessHalloween w/ HitchcockSenior BeatsSenior Day TripsSenior Fitness PlusSenior Game DaySenior SpinSilverSneakers Classic & Renew Active*Languages*I Speak FrenchI Speak ItalianRun Run RudolphZoom Spanish for AdultsZoom Spanish for Middle School and Jr. High SchoolZoom Spanish for High School StudentsZoom Spanish for Kids*Events*Happy Halloween Costume Party *American Red Cross/Health & Safety*Adult CPR/AEDFirst AidPediatric CPR/AEDP1 Program Number *P1 Section Number *P1 Fee *Participant 2 Name (P2) P2 GenderP2 Date of BirthP2 Program TitleChoose One***Fitness***Butts and GutsCardio & Strength TrainingLose the Mat YogaPersonal TrainingPoundReady To RunSalsationSenior Beats!Senior Fitness PlusSenior SpinSilverSneakers Classic & Renew ActiveSpin & FitStep AerobicsStretch & BalanceTai ChiWater - Aqua ArthritisWater - Aqua Kick & BurnWater - Aqua Zumba/Body ScultpingWater - Water Aerobics ***American Red Cross Swim Lessons***Swim Lessons - AdultSwim Lessons - PreschoolSwim Lessons - Teen & AdultSwim Lessons - YouthParent and Child Aquatics***Tiny Tots***2 & 3 School For MeAdult Tot BaseballAdult Tot SoccerBaby Book ClubColors and ShapesFirst ArtLil Dribblers BasketballMovin to MusicMy First Number BookParent & Child AquaticsParent Tot TumblePee Wee PlaygroupShake, Rattle, and RollSticky FingersTiny CelebrationsTots Open Gym ***Early Childhood***Baking BuddiesBitty BasketballBookswormCome and ClayDance It OutDoctor SchoolFall DaysGirls RockGo YogaHealthy KidsJunior ExplorersLearning LettersLittle AmigosLittle NinjasLittle Sluggers and KickersHow to Catch...A Party!Paint LabSports & MoreTeddy Bear Picnic - Mother Daughter Event***Youth***Bring Your RacquetCanine CuisineChalk The WalkCheckmate!Floor Hockey Skills & DrillsGo YogaLearn To SewMicro Soccer U10 IndoorNerf WarsO' Christmas TreePickleball for KidsPlaying Recordder 2Playing Recorder 1Private Piano LessonsSand Volleyball Skills FundamentalsSoftball BasicsStar Wars CookingScout ArcheryTotal SportsYouth BadmintonWood Carving***Youth Basketball***D.A.Y.O.N.E. 1st and 2nd Grade BasketballD.A.Y.O.N.E. Skills TrainingD.A.Y.O.N.E. Youth Basketball LeagueD.A.Y.O.N.E. Skills & DrillsD.A.Y.O.N.E. Center Court***Music Classes***Private Piano Lessons ***Gymnastics***Boys GymnasticsGirls & Boys Advanced Gymnastics (Instructor Permission Required)Girls GymnasticsPreschool Gymnastics***Karate***Kicking TotsPre-Teen Martial ArtsTeen Martial Arts***Teens***Life Skills for Teenage GirlsModern Cartooning - AmimeD.A.Y.O.N.E. Skills TrainingHorror - A Halloween MasterpieceSwim Lessons - Teen & AdultTeen/Adult Explore Archery***Adults***ASL - Mom/Dad and me!ASL - Learn To SignBasket WeavingBeginner Adult PickleballBid WhistAdult CPR/AEDFirst AidParent and Child AquaticsAdult & Senior Dance ClassesMerriest ChristmasThe Grill Cheese MurderESL - English As A Second Language***Seniors***Basket WeavingChair FitnessChristmas ScrabbleHalloween with HitchcockSenior BeatsSenior Fitness PlusSenior Game DaysSenior Day TripsSenior SpinSilverSneakers Classic & Renew Active***Languages***I Speak FrenchI Speak ItalianI Speak Italian Jr.I Speak SpanishZoom Spanish for AdultsZoom Spanish for High School StudentsZoom Spanish Middle School and Jr. HighZoom Spanish for Kids***Events***Deck The House ContestHappy Halloween Costume PartyRun Run Rudolph ***American Red Cross/Health & Safety***Adult CPR/AEDFirst AidPediatric CPR/AEDP2 Program NumberP2 Section NumberP2 FeeParticipant 3 Name (P3) P3 GenderP3 Date of BirthP3 Program TitleChoose One***Fitness***Butts and GutsCardio & Strength TrainingLose The MatPoundReady To RunSalsationSenior BeatsSenior Fitness PlusSenior SpinSilverSneakers Classic & Renew ActiveSpin & FitStep AerobicsStretch & BalanceTai Chi Water - Aqua ArthritisWater - Aqua Kick & BurnWater - Aqua Zumba/Body ScultpingWater - Water Aerobics ***American Red Cross Swim Lessons***Swim Lessons - AdultSwim Lessons - PreschoolSwim Lessons - Teen & AdultSwim Lessons - YouthParent and Child Aquatics*Tiny Tots*2 & 3 School For MeAdult Tot BaseballAdult Tot SoccerBaby Book ClubColors and ShapesFirst ArtLil Dribblers BasketballMovin to MusicMy First Number BookParent & Child AquaticsParent Tot TumblePee Wee PlaygroupShake, Rattle, and RollSticky FingersTiny CelebrationsTots Open Gym*Early Childhood*Baking BuddiesBitty BasketballBookwormsCome and ClayDance It OutDoctor SchoolFall DaysGirls RockGo YogaHealthy KidsHow To Catch...A Party!Junior ExplorersLearning LettersLil DribblersLittle AmigosLittle NinjasLittle Sluggers and KickersPaint LabSports & MoreTeddy Bear Picnic - Mother Daughter Event*Youth*Bring Your RacquetCanine CuisineChalk The WalkCheckmate!Floor Hockey Skills & DrillsGo YogaLearn To SewMicro Soccer U10 IndoorNerf WarsO' Christmas TreePickleball for KidsPlaying Recorder 1Playing Recorder 2Private Piano LessonsSand Volleyball Skills FundamentalsSoftball BasicsStar Wars CookingTotal SportsYouth BadmintonWood Carving*Youth Basketball*D.A.Y.O.N.E. Youth Basketball LeagueD.A.Y.O.N.E. 1st and 2nd Grade BasketballD.A.Y.O.N.E. Center CourtD.A.Y.O.N.E. Skills & DrillsD.A.Y.O.N.E. Skills Training*Music Classes*Private Piano Lessons *Gymnastics*Boys GymnasticsGirls & Boys Advanced Gymnastics (Instructor Permission Required)Girls GymnasticsPreschool Gymnastics*Karate*Kicking TotsPre-Teen Martial ArtsTeen Martial Arts*Teens*Life Skills for Teenage GirlsModern Cartooning - AnimeD.A.Y.O.N.E. Skills TrainingHorror - A Halloween MasterpieceSwim Lessons - Teen & AdultsTeen/Adult Explore Archery*Adults*Adult CPR/AEDAdult & Senior Dance ClassesASL - Mom/Dad and Me!ASL - Learn To SignBasket WeavingBeginner Adult PickleballBid WhistESL - English As A Second LanguageFirst AidMerriest ChristmasParent and Child AquticsTeen/Adult Explore ArcheryThe Grill Cheese Murder*Seniors*Basket WeavingChristmas ScrabbleChair FitnessHalloween with HitchcockSenior BeatsSenior Fitness PlusSenior Game DaySenior Day TripsSenior SpinSilverSneakers & Renew Active*Languages*I Speak FrenchI Speak ItalianI Speak Italian Jr.I Speak SpanishZoom Spanish for AdultsZoom Spanish for Middle School & Jr. High SchoolZoom Spanish for High School StudentsZoom Spanish for Kids*Events*Deck The House ContestHappy Halloween Costume PartyRun Run Rudolph *American Red Cross/Health & Safety*Adult CPR/AEDFirst AidPediatric CPR/AEDP3 Program NumberP3 Section NumberP3 FeeParticipant 4 Name (P4) P4 GenderP4 Date of BirthP4 Program TitleChoose One*Fitness*Butts and GutsCardio & Strength TrainingLose The MatPoundReady To RunSalsationSenior BeatsSenior Fitness PlusSenior SpinSilverSneakers Classic & Renew ActiveSpin & FitStep AerobicsStretch & BalanceTai ChiWater - Aqua ArthritisWater - Aqua Kick & BurnWater - Aqua Zumba/Body ScultpingWater - Water Aerobics *American Red Cross Swim Lessons*Swim Lessons - AdultSwim Lessons - PreschoolSwim Lessons - Teen & AdultSwim Lessons - YouthParent and Child Aquatics*Tiny Tots*2 & 3 School For MeAdult Tot BaseballAdult Tot SoccerBaby Book ClubColors and ShapesFirst ArtLil DribblersMovin to MusicMy First Number BookParent & Child AquaticsParent Tot TumblePee Wee PlaygroupShake, Rattle, and RollSticky FingersTiny CelebrationsTots Open Gym *Early Childhood*Baking BuddiesBitty BasketballBookwormsCome and ClayDance It OutDoctor SchoolFall DaysGirls RockGo YogaHealthy KidsHow To Catch ...A Party!Junior ExplorersLearning LettersLittle AmigosLittle NinjasLittle Sluggers and KickersPaint LabSports & MoreTeddy Bear's Picnic - Mother Daughter Event*Youth*Bring Your RacquetCanine CuisineChalk The WalkCheckmate!Floor Hockey Skills & DrillsGo YogaLearn To SewMicro Soccer U10 IndoorNerf WarsO' Christmas Tree Pickleball for KidsPlaying Recorder 1Playing Recorder 2Private Piano LessonsSand Volleyball Skills FundamentalsSoftball BasicsStar Wars CookingScout ArcheryTotal SportsYouth BadmintonWood Carving*Youth Basketball*D.A.Y.O.N.E. 1st and 2nd Grade BasketballD.A.Y.O.N.E. Skills TrainingD.A.Y.O.N.E. Youth Basketball LeagueD.A.Y.O.N.E. Skills & DrillsD.A.Y.O.N.E. Center Court*Music Classes*Private Piano Lessons *Gymnastics*Boys GymnasticsGirls & Boys Advanced Gymnastics (Instructor Permission Required)Girls GymnasticsPreschool Gymnastics*Karate*Kicking TotsPre-Teen Martial ArtsTeen Martial Arts*Teens*Life Skills for Teenage GirlsModern Cartooning - AnimeD.A.Y.O.N.E. Skills TrainingHorror - A Halloween MasterpieceSwim Lessons - Teen & AdultThe Grilled Cheese Murder - Teen Edition*Adults*Adult & Senior Dance ClassesAdult CPR/AEDBasket WeavingBeginner Adult PickleballBid WhistFirst AidMerriest ChristmasParent and Child AquaticsThe Grill Cheese MurderASL - Mom/Dad and Me!ASL - Learn To SignESL - English As A Second Language*Seniors*Basket WeavingChair FitnessChristmas ScrabbleHalloween with HitchcockSenior BeatsSenior Day TripsSenior Fitness PlusSenior SpinSenior Game DaysSilverSneakers Classic & Renew Active*Languages*I Speak FrenchI Speak ItalianI Speak Italian Jr.I Speak SpanishZoom Spanish for AdultsZoom Spanish for Middle School & Jr. High SchoolZoom Spanish for High School StudentsZoom Spanish for Kids*Events*Deck The House ContestHappy Halloween Costume PartyRun Run Rudolph *American Red Cross/Health & Safety*Adult CPR/AEDFirst AidPediatric CPR/AEDP4 Program NumberP4 Section NumberP4 FeeParticipant 5 Name (P5) P5 GenderP5 Date of BirthP5 Program TitleChoose One*Fitness*Butts and GutsCardio & Strength TrainingLose The MatPoundReady To RunSalsationSenior BeatsSenior Fitness PlusSenior SpinSilverSneakers Classic & Renew ActiveSpin & FitStep AerobicsStretch & BalanceTai ChiWater - Aqua ArthritisWater - Aqua Kick & BurnWater - Aqua Zumba/Body ScultpingWater - Water Aerobics *American Red Cross Swim Lessons*Swim Lessons - AdultSwim Lessons - PreschoolSwim Lessons - Teen & AdultSwim Lessons - YouthParent and Child Aquatics*Tiny Tots*2 & 3 School For MeAdult Tot BaseballAdult Tot SoccerBaby Book ClubColors and ShapesFirst ArtLil Dribblers BasketballMovin to MusicMy First Number BookParent & Child AquaticsParent Tot TumblePee Wee PlaygroupShake, Rattle, and RollSticky FingersTiny CelebrationsTots Open Gym *Early Childhood*Baking BuddiesBitty BasketballBookwormsCome and ClayDance It OutDoctor SchoolFall DaysGirls RockGo YogaHealthy KidsHow To Catch ... A Party!Junior ExplorersLearning LettersLittle Sluggers & KickersLittle AmigosLittle NinjasPaint LabSports & MoreTeddy Bear's Picnic - Mother Daughter Event*Youth*Bring Your RacquetCanine CuisineChalk The WalkCheckmate!Floor Hockey Skills & DrillsGo YogaLearn To SewMicro Soccer U10 IndoorNerf WarsO' Christmas TreePickleball for KidsPlaying Recorder 1Playing Recorder 2Private Piano LessonsSand Volleyball Skills FundamentalsScout ArcherySoftball BasicsStar Wars CookingTotal SportsYouth BadmintonWood Carving*Youth Basketball*D.A.Y.O.N.E. 1st and 2nd Grade BasketballD.A.Y.O.N.E. Skills TrainingD.A.Y.O.N.E. Youth Basketball LeagueD.A.Y.O.N.E. Skills & DrillsD.A.Y.O.N.E. Center Court*Music Classes*Private Piano Lessons *Gymnastics*Boys GymnasticsGirls & Boys Advanced Gymnastics (Instructor Permission Required)Girls GymnasticsPreschool Gymnastics*Karate*Kicking TotsPre-Teen Martial ArtsTeen Martial Arts*Teens*Life Skills for Teenage GirlsModern Cartooning - AnimeD.A.Y.O.N.E. Skills TrainingHorror- A Halloween MasterpieceSwim Lessons - Teen & AdultTeen/Adult Explore Archery*Adults*Adult & Senior Dance ClassesAdult CPR/AEDASL - Mom/Dad and Me!ASL - Learn To SignBasket WeavingBeginner Adult PickleballBid WhistESL - English As A Second LanguageFirst AidMerriest ChristmasParent and Child AquaticsThe Grill Cheese Murder*Seniors*Basket WeavingChair FitnessChristmas ScrabbleHalloween with HitchcockSenior BeatsSenior Day TripsSenior Fitness PlusSenior Game DaySenior SpinSilverSneakers & Renew Active*Languages*I Speak FrenchI Speak ItalianI Speak Italian Jr.I Speak SpanishZoom Spanish for AdultsZoom Spanish for Middle School & Jr. High SchoolZoom Spanish for High School StudentsZoom Spanish for Kids*Events*Deck The House ContestHappy Halloween Costume PartyRun Run Rudolph *American Red Cross/Health & Safety*Adult CPR/AEDFirst AidPediatric CPR/AEDP5 Program NumberP5 Section NumberP5 FeeParticipant 6 Name (P6) P6 GenderP6 Date of BirthP6 Program TitleChoose One*Fitness*Butts and GutsCardio & Strength Training Lose the Mat YogaPoundReady To RunSalsationSenior BeatsSenior Fitness PlusSenior SpinSilverSneakers Classic & Renew ActiveSpin & FitStep AerobicsStretch & BalanceTai Chi Water - Aqua ArthritisWater - Aqua Kick & BurnWater - Aqua Zumba/Body ScultpingWater - Water Aerobics *American Red Cross Swim Lessons*Swim Lessons - AdultSwim Lessons - PreschoolSwim Lessons - Teen & AdultSwim Lessons - YouthParent and Child Aquatics*Tiny Tots*2 & 3 School For MeAdult Tot BaseballAdult Tot SoccerBaby Book ClubColors and ShapesFirst ArtLil Dribblers BasketballMovin to MusicMy First Number BookParent & Child AquaticsParent Tot TumblePee Wee PlaygroupShake, Rattle, and RollSticky FingersTiny CelebrationsTots Open Gym *Early Childhood*Baking BuddiesBitty BasketballCome and ClayDance It OutDoctor SchoolFall DaysGirls RockGo YogaHealthy KidsHow To Catch... A Party!Junior ExplorersLearning LettersLittle AmigosLittle NinjasLittle Sluggers and KickersSports & MoreTeddy Bear's Picnic - Mother Daughter Event*Youth*Bring Your RacquetCanine CuisineChalk The WalkCheckmate!Floor Hockey Skills & DrillsGo YogaLearn To SewMicro Soccer U10 IndoorNerf WarsO' Christmas TreePickleball for KidsPlaying Recorder 1Playing Recorder 2Private Piano LessonsSand Volleyball Skills FundamentalsSoftball BasicsStar Wars CookingTotal SportsYouth BadmintonWood Carving*Youth Basketball*D.A.Y.O.N.E. 1st and 2nd Grade BasketballD.A.Y.O.N.E. Skills TrainingD.A.Y.O.N.E. Youth Basketball LeagueD.A.Y.O.N.E. Skills & DrillsD.A.Y.O.N.E. Center Court*Music Classes*Private Piano Lessons *Gymnastics*Boys GymnasticsGirls & Boys Advanced Gymnastics (Instructor Permission Required)Girls GymnasticsPreschool Gymnastics*Karate*Kicking TotsPre-Teen Martial ArtsTeen Martial Arts*Teens*Life Skills for Teenage GirlsModern Cartooning - AnimeD.A.Y.O.N.E. Skills TrainingHorror - A Halloween MasterpieceSwim Lessons - Teen & AdultTeen/Adult Explore Archery*Adults*Adult & Senior Dance ClassesAdult CPR/AEDASL - Mom/Dad and Me!ASL -Learn To SignBasket WeavingBeginner Adult PickleballBid WhistESL - English As A Second LanguageFirst AidMerriest ChristmasParent and Child AquaticsThe Grill Cheese Murder*Seniors*Basket WeavingChair FitnessChristmas ScrabbleHalloween with HitchcockSenior BeatsSenior Fitness PlusSenior Game DaySenior Day TripsSenior SpinSilverSneakers Classic & Renew Active*Languages*I Speak FrenchI Speak ItalianI Speak Italian Jr.I Speak SpanishZoom Spanish for AdultsZoom Spanish for Middle School & Jr. High SchoolZoom Spanish for High School StudentsZoom Spanish for Kids*Events*Deck The House ContestHappy Halloween Costume PartyRun Run Rudolph *American Red Cross/Health & Safety*Adult CPR/AEDFirst AidPediatric CPR/AEDP6 Program NumberP6 Section NumberP6 FeeYouth Scholarship DonationTOTAL AMOUNT OWED *Your credit card will be charged when registrations are processed.Shirt Sizes *Some, but not all of our programs, provide a t-shirt. Please provide t-shirt sizes for each participant. Questions/CommentsPhoto Release and WaiverBy filling out this form, I authorize the Lan-Oak Park District to use any and all photographs, audio, and/or video that contain my (or that of the participant, if filled out by a parent or guardian) voice, image, likeness, and/or image for promotional and/or publicity purposes. I hereby waive any right to inspect or approve the finished photograph, audio, video, advertising copy, or printed matter that may be used in conjunction therewith or the eventual use to which it may be applied. The Lan-Oak Park District will only use the aforementioned photograph, audio, and/or video, for promotional and/or publicity purposes (i.e. brochures, flyers, website design, cable television program, pamphlets, and/or any other form of media presentations used by the Lan-Oak Park District to promote and/or publicize its recreational programs and event offerings). Transfer/Refund Agreement *I have read and understand the Transfer/Refund Policy for Lan-Oak Park District.Click here for full Trasnfer/Refund Policynbsp;Registration Agreement *I have read and understand the Waiver, Release of All Claims, and Hold Harmless Agreement for Lan-Oak Park District.Click here for full Waiver, Release of All Claims, and Hold Harmless AgreementreCAPTCHA is required.Submit