Summer Recreation Registration

Summer Playground Registration

 

Child’s name: __________________                      Birth Date:________

Address:_______________________                     Age:_____________

Phone:_________ Cell Phone:__________            Gender: M / F

E-mail address:__________________

Parent’s Name_______________________           Work Phone:__________

Address: ___________________________

Insurance Info:_____________________               Policy # ____________

 

Emergency Contact__________________              Phone:______________

Address:___________________________

 

Allergies:___________________________________________________

 

Any other medical concerns:___________________________________

 

    I hereby give the Village of Phelps Recreation staff permission to seek         medical attention for my child if it is a life threatening situation or if they are unable to reach any of the people above.

          Signature:_________________________ Date:____________

 

I hereby give permission to have __________________ photographed and used in the local newspaper or summer playground album.  I release the Village of Phelps from liability.

       Signature__________________________ Date:_____________

 

I also understand that if my child decides to leave during the hours of operation that  he/she are not allowed back into the program until the next day and the Village of Phelps is not responsible for the behaviors or actions of my child.            Signature:__________________

 

 

2024 Summer Recreation dates 7/8/24 – 8/16/24

Appropriate for Ages 5-13, Grades K-8; Mon.-Fri. 1:00-4:00