EAST HAMPTON PARKS AND RECREATION DEPARTMENT Name

EAST HAMPTON PARKS AND RECREATION DEPARTMENT
[email protected]
[email protected]
[email protected]
www.easthamptonct.gov
860-267-7300 (ofc); 860-267-7800 (fax)
MAILING ADDRESS:
20 East High Street; East Hampton, CT 06424
DROP-IN LOCATION:
240 Middletown Ave.; East Hampton, CT 06424
For: Boys and Girls entering grades 2-7
ALL SPORTS CAMP offers a variety of sports. Campers can choose to participate in Sports Clinics
or Recreational Activities. The Clinics emphasize development of skills through instruction, drills,
and games. Recreational Activities will be geared more to playing games. Awards are given out
during the week. Session IV includes swimming.
DATE: July 7th ~ July 11th, 2014
TIME: Mon-Fri, 8:15am-3:00pm
(early drop-off 8:00am-8:15am)
extended 4th session 3~5pm at Sears Park
WHERE:
Sessions 1-3 pick-up at EHHS
Session 4 - Pick up at Sears Park
Camp Staff
Greg Ruel, Bob Boscarino and Jeremy Moore
# OF SESSIONS:
1 Session
2 Sessions
3 Sessions
4 Sessions
COST
$75.00
$120.00
$160.00
$180.00
PLEASE
CHECK:
BRING: Lots of water to drink, snacks, & lunch. If possible, bring shinguards for soccer, gloves for baseball, and racquets for tennis.
(If not, we provide equipment). Bring swimsuit & towel if you are going to Session IV. Lifeguards will be on duty.
Name of Child
DOB
Age
Grade
Medical Information
(in fall)
(list allergies, meds, conditions, etc.)
CONTACT INFORMATION:
HOME ADDRESS:
E-MAIL ADDRESS:
HOME PHONE #:
PARENT/GUARDIAN:
DAY/CELL PHONE #:
ALTERNATE CONTACT:
DAY/CELL PHONE#:
(NAME/RELATIONSHIP:)
TIME PERIOD
SESSION I
8:15AM--10:15AM
SESSION II
10:30AM--12:30PM
12:30PM--1:00PM
SESSION III
1:00PM--3:00PM
SESSION IV
3:00PM--5:00PM
RELEASE:
CLINIC/ACTIVITY
PLEASE CHECK
SOCCER,
VOLLEYBALL, OR
FRISBEE GOLF/COACH'S CHOICE
BASKETBALL,
TRACK & FIELD, OR
GYM GAMES
LUNCH (on school grounds)
BASEBALL,
LACROSSE, OR
TENNIS
PHOTOGRAPHS that are taken
of participants in our programs
may be used in our publicity
(unless a participant, parent,
or guardian indicates otherwise).
SEARS PARK
SWIMMING
I understand that participation in this (these) program(s) involves risks of personal and bodily injury, including but not limited to paralysis, heart attack and death, as well as loss or damange to
property. I realize that activities such as this may be inherently dangerous activities and my design to participate in all such activities is made in full recognition of these risks and is entirely
voluntary. In consideration of your acceptance of this application, I agree for myself, my heirs, successors, and assigns to hold harmless the Town of East Hampton, CT, its affiliates,
subsidiaries and any other entity associated with (these) program(s), and each of their directors, officers, agents, representatives, employees, volunteers, successors, and assigns from all
liability on account of injury, loss claim, or damage to my body, health, wellbeing or property. I further authorize the personnel to act for me according to their best judgment in any emergency
requiring medical attention. I understand that I am responsible for all financial liabilities arising from a situation involving medical treatment. I agree that the terms of this release is applicable to
any and all of my dependents who take part in this (these) program(s). Release is applicable to phone registrations as well.
Parent gives child permission to be bussed to East Hampton High School, Memorial School, or Sears Park depending upon activities enrolled in.
Parent/Guardian:
(signature)
(date)
REGISTER: Completed Registration Forms are accepted by mail, fax, e-mail (as an attachment), or drop off at the Parks & Recreation
office.
PAYMENT: Credit Card # __________________________________________
Expiration: _______________________
3-Digit Sec. Code __________________ Check # _______________ Amount $ ________________________

Download Report