Recreation Family Update Form

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The Town of Henrietta Recreation Department is currently in the early stages of implementing a program and facilities registration software package. With the utilization of this software, we will be able to streamline the registration process for programs and cabin/pavilion rentals. Also, this is just another step in the process to allow for online registration in the future.

A crucial step in the early stages of this process is to have residents fill out a very brief household information form, which is the same information that you will provide when registering in person. By collecting this data from your household now, it will ensure that the registration process is much more convenient for yourself, children and other residents in the near future. We kindly ask that you take a few moments to fill out the form below and submit it to us.

Please direct questions and concerns to the Recreation Department at (585) 359-2540. Thank you in advance for your assistance.

Family Last Name: Date:


Primary Household Member / Guardian
First Name: Last Name:
Address: City: Zip:
Home Phone: Alt. Phone:
Birthdate:       Male  Female      Email: 

Emergency Contact:

Phone:    Relation:



Secondary Household Member / Guardian
First Name: Last Name:
Phone:      Birthdate:       Male  Female      
Current Grade:  (If Applicable)     Email: 
Special Needs:

Additional Household Member 1 (Only if Primary Residence)
First Name: Last Name:
Phone:      Birthdate:       Male  Female      
Current Grade:       Email: 
Special Needs:

Additional Household Member 2 (Only if Primary Residence)
First Name: Last Name:
Phone:      Birthdate:       Male  Female      
Current Grade:       Email: 
Special Needs:

Additional Household Member 3 (Only if Primary Residence)
First Name: Last Name:
Phone:      Birthdate:       Male  Female      
Current Grade:       Email: 
Special Needs:

Additional Household Member 4 (Only if Primary Residence)
First Name: Last Name:
Phone:      Birthdate:       Male  Female      
Current Grade:       Email: 
Special Needs:
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