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Summer Fun Registration
$25 Registration fee waved if you sign up by June 1, 2014

Child’s Name: _____________________________________________________
Grade Entering: ___________  Age: ___________  T-shirt Size: _______
Address: ___________________________________________________________
Parent Name(s): _______________________________________________________
Home Phone: ______________________Cell/Work: __________________________
Email Address:________________________________________________________
Medical Conditions/Medications: __________________________________________
Emergency Contact and Phone #:_________________________________________

$25 Registration fee per family


Session Time
Fee
#1: 8:30am-12pm – ½ day program
$80
#2  8:30am-5pm full day program
$185
#3: 7:30-8:30am early drop off
$25
#4: 9-12 dance program (week of July 7th and week of July 14th)
$80



session

dates
theme
time
fee

1

July 7-11

“Around the World"
2
July 14-18
“Wonders of Nature”
 

 
3
July 21-25
“Hollywood/ Game Show Week”

 
4
July 28-August 1

“Wacky Water Week”
 
5
August 4-8
“Roll Back the Clock”
 

 
 
I agree not to hold responsible the Rutland Recreation Committee; the Town of Rutland; or any of the parties connected with this program for any accident or injury that may occur during the program. I understand that if my child becomes a discipline problem, he/she will be dismissed from the program without a refund. I also grant permission for the Recreation Staff to seek medical care for my child in the event that I cannot be reached.  
(Parent/Guardian):_________________________________Date:___________________
I give permission for pictures taken of my child in this program to be displayed:________

Any registration forms received after July 1, 2014 are subject to a late fee.





 
Town of Rutland 250 Main Street, Rutland, MA 01543   Disclaimer
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