Recreation_Registration_form_08 by chrstphr


									Weymouth Recreation
Where the fun and the friendships begin!

Family Registration Form 2008
Membership (free) is required to register for summer programs. Register carefully! We can not refund fees unless we must cancel the program.

E-mail address: ____________________________________ Keep me current with e-mail updates! Check this box to be added to our e-mail list. You will receive one e-mail per month. Monthly flyers will still be available at our office and all town libraries the first of every month.
Please list the participants in the numbered spaces below: (one family per form). This information is vital. Please fill out the form fully, carefully and clearly. * (parent or guardian’s name)____________________________________ Home phone:_________________________ *Mailing address: Street______________________________Town___________________________zip code________ Work phone: ( )_______________________________ Cell phone: ( )________________________________

Please list each child’s name and date of birth below: 1. ___________________________membership #________ 3. ________________________membership #__________ 2. ___________________________ membership # ________ 4. ________________________membership #__________

It is critical that we have updated emergency and medical contact information. Either indicate below that the information we have on file is still accurate or below update the information we have on file. Then move on to the registration form on the back. I have completed the family membership process. None of my family contact information has changed.
*Emergency contact, relationship and phone number _____________________________________________________ *Family doctor and phone number: ___________________________________________________________________ *Insurance company and policy number: _______________________________________________________________ * REQUIRED INFORMATION

T-Shirts are required for many summer programs.
T-shirts are based on age range. Weymouth Recreation will require all participants in the Sprouts, Wey-Rec, Great Esker Park, and the Exceptional Program (still all orange) to wear an age-specific t-shirt to the program each day. This policy is designed to assist the staff in identifying our program participants quickly and surely. Shirts cost $7.00 and are available now at our office. If the color is approriate previous years shirts are still good this year.

Summer programs require an age appropriate Weymouth Recreation t-shirt. Age (years): 3–4 red 4–6 gold; 6–8 stonewash green; 8-10 lime green & 10+ stonewash blue Exceptional Program – all orange. T-shirts are $7.00 each

Register carefully! There are absolutely no refunds unless we must cancel the program.

IMPORTANT - LIABILITY WAIVER AGREEMENT Liability Release / Registration: registration for minors must be by the parent or guardian. Your registration acknowledges that you understand the inherent risk in all recreational and sports programs and will not hold the Weymouth Recreation Division, its’ staff or the Town of Weymouth responsible in the case of accident, injury or loss of personal property. We have no medical personnel on staff. Health concerns (allergies, asthma …) of any participant must be made known in writing to the Recreation Office. *Required - I have READ and AGREE to the above waiver (please sign) ____________________________________

Participant name

Program name and code

Start date



________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________

Please let us know of any health concerns of any program participants listed above:

Check this box and fill in amount to donate ($5, $10, $20, $50 - or any amount) to our scholarship $____________ fund to make a great summer possible for income eligible or special circumstances applicants. Please list all programs and t-shirts above. Payment method: cash check # ________ credit card There are absolutely no refunds unless we must cancel the program. Total _____________

To top