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Ellington Senior Center Program Registration Form

  1. This form is to be used when registering for a program that requires a fee and/or is limited in size. All programs participants must have a current year's "Registration Form" (aka waiver) on file. A separate "Program Registration Form" must be submitted for each program prior to the start of a new session.

  2. Submit this completed form, along with full payment, to the receptionist. Partial payments are not accepted, unless specified otherwise. Registrations will be accepted on a first come, first serve basis. Preference will be given to Ellington residents.

  3. IMPORTANT: All payments for programs are non-refundable, and make-up classes are not permitted, unless the Senior Center Cancels.

  4. Office use only

  5. Payment method

  6. Approved space in program: Y/N

  7. Wait List: Y/N

  8. Completed Annual Registration verified on file? Y/N Initials ________

  9. Leave This Blank:

  10. This field is not part of the form submission.