East Haddam Parks and Recreation
Summer Day Camp 2008
Day Camp

My child will be attending the following :

Middle School Camp	Elementary School Camp	After Care (Elem. School ONLY)
___WEEK 1- June 30- 3 ___Field Trip	___WEEK 1- June 30- 3 __Field Trip	WEEK 1___M___T___TH
___WEEK 2- July 7-10  ___Field Trip	___WEEK 2- July 7-11  ___Field Trip	WEEK 2___M___T___W___TH
___WEEK 3- July 14-17 ___Field Trip	___WEEK 3- July 14/18 ___Field Trip	WEEK 3___M___T___W___TH
___WEEK 4- July 21-24 ___Field Trip	___WEEK 4- July 21-25 ___Field Trip	WEEK 4___M___T___W___TH
___WEEK 5- July 28-31  ___Field Trip	___WEEK 5- July 28-1 ___Field Trip	WEEK 5___M___T___W___TH
___WEEK 6- Aug. 4-7   ___Field Trip	___WEEK 6- Aug. 4-8  ___Field Trip	WEEK 6___M___T___TH

Child’ Name _________________________Age ___DOB ______ Grade Entering _______
Parent/Guardian    ___________________________ Home Phone___________________  
Mailing Address   ______________________________________________________    
Business Phone   _______________________ Cell Phone ________________________   
Emergency # if can’t be reached      ____________________________________________
Contact Person & Relation   ________________________________________________   
Are there any physical limitations or allergies which would restrict your child’s activities or that the staff should be aware of ?    No Yes   __________________________________    
Taking Medications No Yes     _________________________________________________
Child’s Physician   _____________________________  Phone #  ____________________ 
Would you consider your child to be a   ___ beginner    ___ intermediate    ___ advanced    swimmer?

Is there any other person authorized to pick up your child from the program? No Yes
If yes, Name    _________________________________ Relationship  _________________
Address _____________________________________    Phone Number  _______________
I hereby give permission for    ________________________________  to participate in the East Haddam Recreation Summer Day Camp program. I understand I am responsible for transportation to and from camp in a timely fashion. I also grant permission for the program director or designee to admit my child to the hospital/or walk-in clinic if deemed necessary by reason of illness or injury in the event I cannot be reached. I assume responsibility for the medical coverage for any injury or illness that may occur.
Signature of parent/guardian ___________________________________ Date ___________

• Please make checks payable to East Haddam Parks and Recreation.
• Completed registration forms and payment should be mailed to
• East Haddam Parks and Recreation, P.O. Box 278, East Haddam, CT 06423.