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Household Information Form

 

— I M P O R T A N T —
Please return this form promptly.
Form must be filled out if not previously submitted.

Proof of residency is necessary to guarantee that only residents living within the Park District's boundaries receive discounted rates.

Required Form and Proof of residency
Please complete all of the information below and click the Submit button to send in your Household Information Form.

If you are a park district resident you must also send us a copy of a current utility bill, driver's license or state ID.

After submitting this form, you can email your proof of residency to registration@stcparks.org or you can mail it to: Pottawatomie Community Center, 8 North Avenue, St. Charles, IL 60174.

All information marked * below is required to process your form.

Are you a resident of the St. Charles Park District? *   Yes    No

Head of Household
Last Name *	First Name *	Birth Date * mm/dd/yy	Sex *	Primary Phone * xxx-xxx-xxxx	Secondary Phone xxx-xxx-xxxx
			M  F
Address: * City: * State: * Zip: * E-mail Address: * * Please provide your email address for park district updates and information. The park district will keep all e-mail addresses confidential. Household Members at address above:
Last Name	First Name	Birth Date mm/dd/yy	Sex	Special Accommodations
			M  F
			M  F
			M  F
			M  F
			M  F
			M  F