The Den 2019-2020 Registration Form

  • Date Format: MM slash DD slash YYYY
    Date of Birth
  • *As of August 2019
    *There is a $25.00 Registration Fee/Child*
    There is a minimum 1-hour fee will be charged per day/per session your child is to attend. *Please note that your days must remain the same throughout the course of the school year. Schedule changes will be based on approval.
    Please select the preferred days your child will attend (must be consistent) $7 per hour fee
  • Emergency Contact Full Name #1
  • Full address, include city and zip
  • Emergency Contact Full Name #2
  • Full address, include city and zip
  • Doctor's full name
  • The Manhattan Park District will not dispense medication to a minor child or any other participant until the Permission and Waiver to Dispense Medication and Medication Information Form Have been fully completed by a parent or guardian.
  • Please include Medication Name, Dosage, Time Taken, and Doctor's Name.
    By registering your child for The Den program, you agree that you are responsible for the payment of all program fees and costs set forth in the program payment schedule. The Park District offers a multiple family discount listed below for The Den Program. If at anytime the Park District is closed on a billing date, payment will be processed the following business day.
    *Rate discount applies .50 cents per extra child registered per hour (hourly discount only) 2nd Child hourly rate $6.50 per hour, 3rd Child hourly rate $6.00 per hour.
  • Please list the responsible person for financial obligations on your child’s account. This the person will receive all billing information, is responsible for tuition payments, and financial discussion of the account. Please include Name and Contact Phone #
  • Please debit my checking or savings account as listed below
  • This field is for validation purposes and should be left unchanged.