Bartlett Park District  •  700 S. Bartlett Rd. •  Bartlett, IL 60103  •  630.540.4800  •  www.BartlettParks.org
 
Bartlett Park District
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On-Line Club Application

Please provide the following household information:

(* Fields Required)

  Account Information
Please answer the following 2 questions which will be your Security/Challenge questions:
    Town/City where you where born?*
    Your mother's maiden name ?*
  Head of Household Information
Name of Primary Guardian: (First) * (Last) *
  Email Address:*
  Home Phone w/area code:*
  Work Phone w/area code: Ext.
  Address Information
  Mailing address:*
  City:* State:* Zip:* Country:
  Are you a Bartlett Park District resident?:* Yes No

Please complete the following information for every
family member that will be using our services:
(All information is treated confidentially and used only for placement purposes).

 

Family Member Information

A Family Membership Consists of parents and their unmarried chidren 24 years and under, residing at the same address.

Student Members need to provide proof of full-time school schedule (12 or more hours).

(*All Fields Below are Required for at least one Family Member)

# First Name* Last Name* Gender* Date of Birth*
(mm/dd/yyyy)		 Grade*
1 M F
2 M F
3 M F
4 M F
5 M F
6 M F
7 M F
8 M F
9 M F
10 M F


 

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