CITY OF CROOKSTON Enrollment Form  

First Name: ___________________________________________________

Last Name: ___________________________________________________

Street Address: ________________________________________________

Zip Code: _____________

Email Address: ________________________________________________

Phone #1:_____________________________

           #2:_____________________________

           #3:_____________________________

           #4:_____________________________

           #5:_____________________________

Email  #1:_____________________________

           #2:_____________________________

This form can be either dropped off or mailed to the City of Crookston at 124 N. Broadway, Crookston , MN 56716