HE
FORM
register at mortongroveparks.com | 2017/2018 Winter|Spring Activity Guide
57
Household Enrollment Form
The Morton Grove Park District has transitioned to a new registration system.
Help us help you in creating your NEW Household Account.
COMPLETE this form and submit it to Prairie View Community Center. PLEASE NOTE: All current households have been
transferred to the new system BUT all households will need to show proof of residency by providing two forms of identifi cation.
Prairie View Community Center, 6834 Dempster St, Morton Grove, IL 60053
Phone: (847)965-1200 Fax: (847)965-4115
mortongroveparks.com
PRIMARY GUARDIAN FIRST AND LAST NAME _______________________________________________________________________________________
ADDRESS ______________________________________________________ CITY _________________________ ZIP ________________
PRIMARY PHONE ______________________________________ OTHER PHONE _______________________________________________
EMAIL ADDRESS __________________________________________________________________________________________ BIRTH DATE __________
SECONDARY GUARDIAN FIRST AND LAST NAME ____________________________________________________________________________________
ADDRESS ______________________________________________________ CITY _________________________ ZIP ________________
PRIMARY PHONE ________________________________________ OTHER PHONE _____________________________________________
EMAIL ADDRESS __________________________________________________________________________________________ BIRTH DATE __________
ADDITIONAL FAMILY MEMBERS (FIRST AND LAST NAME) SCHOOL BIRTH DATE GENDER
M F
M F
M F
M F
M F
M F
M F
RESIDENCY VERIFIED
□ STAFF INITIALS __________
