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2. Eastham Recreation Department Adult Registration Form

   Please complete the form below in its entirety in order to participate in the Town of Eastham recreational programs. 

3. 
5. Name*
6. Email Address
8. Address*
10. City*
11. State*
12. Zip Code*
14. Phone Number*
16. Emergency Contact Name:*
17. Emergency Contact Phone:*
19. Allergies/Medical Concerns:*
21. Do you have medical insurance?*

    1. Yes
    2. No
23. Medical Release Agreement:*

    1. I agree
    2. I disagree and will NOT be allowed to participate

    I, the undersigned, understand that there is an inherent risk in recreational programs and that the range of injury can be minor to severe. I also understand and accept that in the case of injury, the Town of Eastham is responsible only for basic First Aid treatment. I further understand that participation in recreation programs required all participants and spectators to behave in a sportsman-like manner. 

25. Media Release Agreement: *

    I, the undersigned, also understand that pictures/video taken in connection with this program/event may be used for promotional purposes for the Town of Eastham.

    1. I understand & agree
    2. I disagree and will NOT be allowed to participate
27. Participant Required Electronic Signature*

    By typing your full name below you agree to the above terms of participation.

28. Date Signed*
    Date Signed
30. Questions?

    Please call the Recreation Department at (508) 240-5974 or email Rcereation@eastham-ma.gov. 

    Thank you!

Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field