Summer Camp - Delanco Township, New Jersey

DELANCO SUMMER CAMP REGISTRATION

Childs First nameone child per registration

Childs Last name

Current age

Childs Date of Birth

T Shirt size

Current gradeMust be 1st - 5th grade(child must have completed Kindergarten to enroll), or home school children ages 6-11). No pre-school aged children.

Pickup PersonIf nobody other than self, fill in Nobody

Email Address

Home AddressStreet address

City

ZIP

Home Phone Number

Cell Phone Number

Work Phone Number

Please Check the Weeks Your Child Will Attend

I understand that my balance MUST be paid prior to June 20TH any UNPAID BALANCES will result in my child not being able to attend camp until the balance is paid. Your child will not be registered for unpaid weeksI understand my balance

I understand that the first week payment is NOT refundable. This includes if my child registers for only 1 week, and does not attendI understand NOT refundable

*Please make checks/money order payable to: Delanco Recreation Commission. Payments can be made by cash payments at the Delanco Township Municipal Building; PayPal (see website), or check/money order can be mailed to Summer Camp Program 770 Coopertown Rd. Delanco NJ 08075.

NOTE: Lunches will NOT be provided.

CONSENT AND ACKNOWLEDGEMENT

I HAVE READ AND AGREE TO ALL BELOWINFORMED CONSENT AND ACKNOWLEDGEMENT

I hereby give my approval for my child’s participation in any and all activities prepared by Delanco Recreation Summer Camp Staff being held at Dobbins Memorial United Methodist Church. In exchange for the acceptance of said child’s candidacy by the Delanco Recreation Commission. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless the Township of Delanco, and the Delanco Recreation Commision, and all Summer Camp employees, and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury to said child, I hereby waive all claims against. including all staff, volunteers and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. I understand that there is a risk of being injured that is inherent in all activities. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

SUMMER CAMP TRIPS

As a parent or guardian of Registered child, a minor, I give my permission for him/her to participate in Summer Day Camp Program Field Trips outside of Dobbins United Methodist Church AND/OR Other Events sponsored by the Delanco Recreation Commission.

I HAVE READ AND AGREEINFORMED CONSENT TO ATTEND TRIPS

Name of Parent or Guardian

Email Address of Parent or Guardian

Date

ELECTRONIC SIGNATURE

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE. FURTHERMORE, I AM STATING THAT I HAVE READ AND AGREE TO ABIDE BY ALL POLICIES CONTAINED WITH THE ANTIBULLING POLICY AND BEHAVIOR AGREEMENT. I ALSO CERTIFY THAT I HAVE DISCUSSED ALL POLICIES, AND THERE MEANINGS WITH MY CHILD(REN).

SIGNATUREplease type your name.