ARE YOU A DEVILS FAN? COME WITH FRIENDS OR FAMILY AND SEE THE NEW JERSEY DEVILS PLAY THE COLUMBUS BLUE JACKETS FRIDAY, MARCH 6! Meet in the Westfield Area Y Main Lobby at 5:00PM Pickup at Westfield Train Station (time TBD based on game end time). Parents will be called for pickup time. $75 fee includes transportation, game ticket, $10 food voucher and Y adult chaperone counselors (grades 4 and up do not need a parent) Y membership is not required … so invite a friend! Register online or at the Welcome Center by 2/27 (prog. #: 1TNDEVILSMAR) Event Participation Form with parent signature required. Questions? Contact Marty Collett at 908-233-2700 x405 or [email protected] WESTFIELD AREA Y ▪ visit us at westfieldynj.org Main Y Facility ▪ 220 Clark St., Westfield, 908-233-2700 I give my child,_________________________________ ,permission to attend the Westfield Area Y Harlem Devils Trip on March 6, 2015 I understand that you will be traveling via NJ Transit train and leaving from the Westfield Area Y at approximately 5:30 you will be returning to the Westfield Train station between 10:00pm and 11:00pm (all parents will be called about pickup on train ride home. ) I also understand that the cost of the trip covers admission into the game, transportation, $10 food voucher for the Prudential Center and chaperones. I will send my teen with money to purchase additional food and or souvenirs if they desire. Parents are invited to inquire about chaperone availability. All chaperones are responsible adults, college age or older and will remain with their designated group (10 or less) for the entire event. Parents and/ or other adults are welcome Credit / Refund Policy: Registration Fees are non-refundable. In the event you need to cancel your teen’s registration you must do so at least 6 days before the trip (March 6) and you will receive a credit, minus a $10 administrative fee. No credits will be issued if cancellation is done later than specified. Trips may be cancelled due to low enrollment or poor conditions resulting in a full refund of your payment. I understand that if I cannot be reached in an emergency, that the Y’s nurse/EMT or a local hospital/rescue squad will be sought for my teen and that repeated efforts will be made to contact me in that situation. I’ve included below, some contacts in case of an emergency. I give the Y permission to photograph my teen during the trip for use of publicity in their website, brochure, newsletter, or local newspaper. ________ init. I agree to hold harmless the agents and employees of the Westfield Area Y of any and all liability arising from participating in any activity or use of equipment or facilities. Cash, check and credit cards accepted. Payment and registration must be submitted at the Y’s Welcome Center no later than February 27, 2015. Thank you, Marty Collett Director of Youth, Camp & Teen Services Westfield Area Y 908-233-2700 Ext. 405 [email protected] __________________________________ _________________ Parent/Guardian Signature _____________________________________________________ Date P/G Email ______________________________ ______________________________ ___________________________________ Parent / Guardian Name Home # Cell # (Please Print) _______________________________ Emergency contact (other than above p/g) __________________________ Cell # _____________________________ Relation _______________________________ Emergency contact (other than above p/g) __________________________ Cell # _____________________________ Relation Any other important information we need to know (allergies, medications etc.) _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________