EB2Gov POS

Summer Camp Waitlist - email lash@pemibaker.org

Summer Rec Program Registrations

Parent/Gaurdian Name:

Mailing Address:

Town & Zip Code:

Cell Phone Number:

Child's Name:

Shirt Size:

Date of Birth:

Grade:

Summer Camp Options:

Other Camp Options:

Summer Programs:

Assigned Gender:

What is your preferred gender?:

Allergies/Meds/Limitations:

Please select any of the following true statements:

Please tell us a little about your child:

List any known planned abcences this summer:

Child's Name:

Shirt Size:

Date of Birth:

Grade:

Summer Camp Options:

Other Camp Options:

Summer Programs:

Assigned Gender:

What is your preferred gender?:

Allergies/Meds/Limitations:

Please select any of the following true statements:

Please tell us a little about your child:

List any known planned abcences this summer:

Child's Name:

Shirt Size:

Date of Birth:

Grade:

Summer Camp Options:

Other Camp Options:

Summer Programs:

Assigned Gender:

What is your preferred gender?:

Allergies/Meds/Limitations:

Please select any of the following true statements:

Please tell us a little about your child:

List any known planned abcences this summer:

Amount:

EB2Gov Fee:

Quantity:

Payment Amount:

Notes:

I have opened and viewed this program manual:

CLICK HERE- Summer Camp Manual

PLEASE READ AND CHECK THE BOX TO ACKNOWLEGE THE RELEASE OF ALL CLAIMS: In consideration of the permission granted for the participant named above to take part in the above named Recreation program, I hereby release for myself and my heirs, the Town of Plymouth, its agents, employees, volunteers and other program participants from all actions, damages and claims that may result in personal injuries and property damages. I recognize there may be inherent dangers in participating in Recreation programs which may present a strain on the body and its parts, and furthermore, I represent that to the best of my knowledge the participant is in proper physical condition to allow participation. I therefore assume all risks associated with participation in said program. I understand that, in case of injury or illness, the Recreation department will attempt to contact the parent/guardian listed above. In the event of a medical emergency, I consent to the participant’s treatment by a medical doctor and I agree to pay all costs associated with said treatment, including transportation to a medical facility. I, the undersigned, have read this release and understand all its terms and implications and I hereby execute this release of my own free will and with full knowledge of its significance.

Information

Child #1

Child #2

Child #3

Transaction Details