2. Class Information
6. Title of Class*
   Please enter the desired class title
7. Day of Class*
   Please enter the day the class is held
8. Time of Class
   Please enter the time the class is held (if applicable).
12. Personal Information
14. First Name*
15. Last Name*
17. Address1*
19. City*
20. State*
21. Zip*
23. E-Mail*
24. Contact Number*
26. Reservations for Children
    If you are reserving spot for a child please enter their name below
28. Child's First Name
29. Child's Last Name
31. Town Waiver
    Liability Waiver: PLEASE NOTE: All programs are held at the Pepperell Community Center, unless otherwise instructed. If Pepperell schools are cancelled, then daytime programs are also cancelled. Pepperell Recreation does not discriminate on the basis of race, religion, nationality or ethnic origin in all of its programs and/or policies. We reserve the right to dismiss any individual from a program if behavior is deemed inappropriate and corrective action is not taken. I hereby give my permission for myself/my child(ren) to participate in Pepperell Recreation’s Course offering. I am aware of and assume all risks and hazards incidental to such participation, and I hereby waive, release and agree to hold harmless the Town of Pepperell, its Recreation Department, sponsors, volunteers and staff for any claim arising out of injury to myself or my child or property damage that might occur. In the event that I’m unable to be contacted in any emergency, I hereby give permission to the Town of Pepperell Recreation Department to hospitalize and/or secure proper medical treatment for myself or my child
33. SIgnature*
    Please enter your name to agree to Town Waiver
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field