Grandparents Day

S u n d a y, S e p t e m b e r 8 , 1 : 0 0 - 4 : 0 0 p m @ Ya n n e y P a r k

Registration Deadline is September 4.

Registration is limited to 150 participants so
don’t wait to register!

Please call Kearney Park and Recreation (308-237-4644) or

visit kprregister.org for more information or to register.

REGISTRATION FORM
Grandparent’s Name(s):
___________________________________________________________ Send Form To:
Grandchild’s Name(s): Kearney Park &
___________________________________________________________
Recreation
Address: _________________________________________________ P.O. Box 1180
Kearney, NE 68848
Home Phone: ______________________
Grandchild’s Grade(s):____ _________________
Peterson
Grandchild’s Birthday(s): ____________________ Senior
Amount Enclosed: _________________ Activity
Center
❑ Cash/Check** ❑ MasterCard ❑ VISA ❑ Discover
Card #: _________________________________ Exp. Date: ________ CCV# _______

Authorized Signature:

_____________________________________________
**Checks payable to City of Kearney Yanney address:
This is not a Kearney Public Schools program 2020 W 11th St. Kearney, NE