<p> EWING TOWNSHIP RECREATION DEPARTMENT</p><p>2017 SUMMER BASKETBALL CAMP</p><p>BASKETBALL: Boys & Girls: Grades 4 – 8 Location: Ewing High School Gyms</p><p>CAMP Session: Monday, June – 26th – Friday, June 30th, 9am – 3pm,</p><p>Daily activities: 3 on 3, skills, speakers, prizes, awards & more</p><p>Cost: $75 per camper, T Shirt included</p><p>Registration Deadline: June 19th Director: Shelly Dearden, EHS Boys’ Basketball Head Coach</p><p>FOR MORE INFO CONTACT THE EWING RECREATION DEPARTMENT AT 883-1776 X 2 OR EMAIL Ted at [email protected]. </p><p>Camp Registration Information </p><p>Name:______Date:______</p><p>Address:______</p><p>School:______Present Grade:______Gender:______</p><p>Medical Conditions:______</p><p>Emergency Contact Info:______</p><p>Please list people dropping off and picking up camper. Staff may ask for ID.</p><p>1.______2.______</p><p>______Office Use Only______</p><p>Amount $______Cash______Check #______Credit Card______</p><p>Date:______Receipt#______Staff:______ACKNOWLEDGMENT OF RISK - Program: Summer Camps </p><p>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. </p><p>Parent/Guardian______Date:______Signature</p><p>Print Name______</p>