Newport Recreation Department Registration Form

Newport Recreation Department Day Camp Application 2007
Campers Name
Address
Mailing address
Date of birth Age
Email address @
Father's Name
Cell# Work# Home#
Mother's Name
Cell# Work# Home#
Emergency Contact Name
Cell# Work# Home#
Waiver of Participation
I/we assume all risks and hazards incidential to the conduct of the program. I/we do further hereby release, absolve indemnity and hold harmless the Newport Recreation Day Camp, The Newport Recreation Department, The Town of Newport and its Officers. In the event of an emergency requiring medical attention, I hereby grant permission to a physician or hospital personnel designated by the Newport Recreation to attend to my child. I expect notification before hospitalization.
Parent/Guardian Signature
Print Names: Father_____________		Mother
Please check the week(s) your child WILL be attending camp. ** Trips are taken on Wednesdays & are Subject To Change **
Week 1	July 2-July 6	ELLACOYA STATE PARK	________
Week 2	July 9-13	WATER COUNTRY	________
Week 3	July 16-20	SURFCOASTER	________
Week 4	July 23-27	OCEAN/ODEON POINT	________
Week 5	July 30-Aug 3	WHALES TALE WATER PARK	________
Week 6	Aug 6-10	WEIRS BEACH WATER SLIDE	________
Week 7	Aug 13-17	CANOBIE LAKE PARK	________
Week 8	Aug 20-24	MYSTERY TRIP, Auction, pizza, cake & ice cream	________
Registration fee $__________ Paid $____________
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