www.townofstonypoint.org > Recreation Department > Playground Program Registration

Town of Stony PointPlayground Program

 
Town of Stony Point Camps
Child's Name:
Sex:
Address:
DOB:
Age:
Grade:
Parents Names:
Telephone:
Cell:
Email:
Emergency Contact:
Phone:
Family Doctor:
Telephone:
Please select week(s) registering for:
1 2 3 4 5 6
I agree.
(by not agreeing you will not be permitted to register for the Town’s Camp Programs):
PLEASE MAKE CHECKS PAYABLE TO: Town of Stony Point
** I hereby give consent for my child to participate in the program indicated.
I give permission for pictures to be taken of my child:
In the event a parent cannot be reached I authorize my child to be treated by either an EMT, physician or other medical staff:
Please Note: Our programs are licensed by the NYS Dept. of Health and requires two inspections yearly. Inspection reports concerning the camps are filed in the Directors offices.
Medical History
Child's Name:
List any chronic illnesses:
List any special needs, allergies, diets, other restrictions:
List any medications or treatments:
List any other conditions that we should be aware of
PLEASE SUPPLY A COPY OF CURRENT IMMUNIZATION RECORDS.
NO CHILD CAN ATTEND THE PLAYGROUND PROGRAM WITHOUT A COPY OF IMMUNIZATION RECORDS ON FILE.
To the best of my knowledge the above information is correct.
Parent/Guardian Signature:
NO REFUNDS OR PRO-RATED FEES
** Proof of residency and payment must be provided to secure your child's spot. 60 campers will be accepted per week.

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