Ewing Township Recreation Department

EWING TOWNSHIP RECREATION DEPARTMENT

2017 SUMMER BASKETBALL CAMP

BASKETBALL: Boys & Girls: Grades 4 – 8 Location: Ewing High School Gyms

CAMP Session: Monday, June – 26th – Friday, June 30th, 9am – 3pm,

Daily activities: 3 on 3, skills, speakers, prizes, awards & more

Cost: $75 per camper, T Shirt included

Registration Deadline: June 19th Director: Shelly Dearden, EHS Boys’ Basketball Head Coach

FOR MORE INFO CONTACT THE EWING RECREATION DEPARTMENT AT 883-1776 X 2 OR EMAIL Ted at [email protected].

Camp Registration Information

Name:______Date:______

Address:______

School:______Present Grade:______Gender:______

Medical Conditions:______

Emergency Contact Info:______

Please list people dropping off and picking up camper. Staff may ask for ID.

1.______2.______

______Office Use Only______

Amount $______Cash______Check #______Credit Card______

Date:______Receipt#______Staff:______ACKNOWLEDGMENT OF RISK - Program: Summer Camps

I am aware that participating in this activity can be dangerous and involves risk of injury. I realize that participation in the above-mentioned activity presents risk, which includes minor or serious injury to any part of the body. These injuries could lead to temporary or permanent disability or even death. While the possibility of serious injury to participants is unlikely, it is important that all participants and parents realize that these risks do exist. PARENT/GUARDIAN AGREEMENT: In consideration of the Ewing Recreation Department permitting the name minor to participate in the Recreation Department previously mentioned, the undersigned, being the parent(s) or legal guardian of ______hereby waive and relinquish all claims I (we) may have as a result of said minor participating in the program against the Ewing Township Recreation Commission, Ewing Township Recreation Department and Ewing Township Mayor and Council, its offices, agents, servants and employees from any and all claims for injuries including death, damage or loss of property which may accrue to us on account of the minor's participation in said program and we further agree to hold harmless the Ewing Township Recreation Commission, Ewing Recreation Department and Ewing Township Mayor and Council, its officers, agents, servants, and employees from any and all such claims.

Parent/Guardian______Date:______Signature

Print Name______