East Haddam Parks and Recreation

Registration Form

Please fill out one form per person.
Please submit payment with registration form.
Please mail form and payment to:
East Haddam Park and Recreation
P.O. Box K
East Haddam, CT 06423
You can drop off completed forms at the Selectman’s Office or the Recreation office,
7 Main St., East Haddam, CT.
If you have any questions, please call Tiffany at the Recreation office at 873-5058.

Name_________________________________________________Age/Grade_________

Mailing Address__________________________________________________________

Daytime Phone_________________________Evening Phone______________________

E-Mail Address __________________________________________________________

Emergency Contact Name/Phone_____________________________________________

Are there any pertinent medical conditions that we should be aware of?______________

________________________________________________________________________

Name of the program that I am registering for:__________________________________

Program Fee amount that I have enclosed:______________________________________

By signing this form to register for the above listed program, I understand that there may be an inherent risk involved in my/my child’s participation. I understand that I am solely responsible for any medical, financial, legal or other expenses that may occur from my/my child’s participation. I understand that I cannot hold the Town of East Haddam, East Haddam Parks and Recreation, it employees, volunteers or representatives liable for any injury or accident that may occur.

__________________________________________________   ___________________

Participant(if age 18 or older) or Parent/Guardian Signature         Date