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Summer Fun 2013
RUTLAND RECREATION
SUMMER FUN REGISTRATION 2013

Child’s Name:_________________________________________________________ Grade Entering______ Age______
Parent’s Name______________________________________________________________________________________
Address:___________________________________________________________________________________________
Home Phone:____________________________________ Cell/Work:__________________________________________
E-Mail:_________________________________________________________  T-Shirt Size:__________     youth      adult
Emergency
Contact:(other than parent)______________________________________________ Phone:_________________________

Medical Conditions & Medications:________________________________________________________________________
Fees:   $80/week        9am-12pm – ½ day program
        $85/week        8am-12pm – ½ day program with early drop-off
       $185/week       8am-5pm full day program
Week 1 - July 8th “Color Wars”
_____ 9am-12pm                   _____ 8am- 12pm – early drop-off               _____ 8am-5pm full day
_____ 9am-12pm – Dance program
Week 2 - July 15th “Sports & Games”
_____ 9am-12pm                   _____ 8am- 12pm – early drop-off               _____ 8am-5pm full day
_____ 9am-12pm – Dance program
Week 3 - July 22nd “Party in the USA!”
_____ 9am-12pm                   _____ 8am- 12pm – early drop-off               _____ 8am-5pm full day

Week 4 - July 29th   “Wacky Water Week”
_____ 9am-12pm                   _____ 8am- 12pm – early drop-off               _____ 8am-5pm full day
Week 5 - August 5th “Amazing Race”
_____ 9am-12pm                   _____ 8am- 12pm – early drop-off               _____ 8am-5pm full day
Week 6- August 12th   Pre-Engineering with Lego  ages 5-7                  ___ 9am-12pm      Fee: $150
                       Engineering Fundamental with Lego  ages 8-11 ____1pm-4pm       Fee:$150

I agree not to hold responsible the Rutland Recreation Committee; the Town of Rutland; or any of the parties connected with this program for any accident or injury that may occur during the program. I understand that if my child becomes a discipline problem, he/she will be dismissed from the program without a refund. I also grant permission for the Recreation Staff to seek medical care for my child in the event that I cannot be reached.  Cancellation/Refund Policy will be strictly enforced.
Signature (Parent/Guardian):____________________________________________________________Date:____________
I give permission for any pictures taken of my child in this program to be displayed: __________(initial)
CK #:______________ Date:______________ Amount:______________



 
Town of Rutland 250 Main Street, Rutland, MA 01543   Disclaimer
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