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UTLT Fall 2013 Registration
Floor Hockey for grades K-2 (Jenny Morris)                         Fee $35 / 4 weeks
3:45-4:45         11/25, 12/2, 12/9, 1/4

Fitness Fun for grades 6-8 (Sherry Rotondo)                        Fee $50/6 weeks
2:45-3:30          11/5, 11/19, 11/26, 12/3, 12/10, 12/17

Super Sports for grades 3-5 (Fast Athletics)                         Fee: $60/6 weeks
3:45-4:45           11/5, 11/19, 11/26, 12/3, 12/10, 12/17

Kids Zumba /Yoga for grades 3-5~~ (Kate Mellecker)           Fee: $35/4 weeks (ongoing)
3:40-4:40pm         10/30,11/6, 11/13, 11/20,
Floor Hockey for grades 3-5 (Jenny Morris)                          Fee: $35/4 weeks
3:45-4:45         11/21, 12/5, 12/12, 12/19

Pre-Engineering With LEGO for grades K-2                          Fee: $150/8weeks
3:45-5:15pm    11/14, 11/21, 12/5, 12/12, 01/2, 01/9, 01/16, 01/23

To register, fill out the information below and mail it or drop it off to Rutland Recreation, 250 Main St. (508) 886-0048.  (Pease do not send forms to the school).~~~ Make checks payable to “Rutland Recreation”.~ We will contact you if class is cancelled due to lack of enrollment. 30 children maximum for each class. Confirmations are not sent.~ Please send a note to your child’s homeroom teacher making them aware of their participation. Please send a peanut free snack with your child.~
Student’s Name: _____________________________ Age:~_____________Grade: ___________
Parent’s Name: ________________________E-mail: _________________________________
Home Phone: _________________________Cell/Work Phone: _________________________
Medical Considerations: _________________________________
Teacher: ___________________~ Naquag~~ ~ ~~~~~~~~~~~ Glenwood~~~~~~~~ ~~~~~~~~~~ CTMS
Program Name/Day: _________________________________________~Fee: $_______

I agree not to hold responsible the Rutland Recreation Commission; the Town of Rutland; the owners of the premises where the program is held; or any of the parties connected with the program for any injury or accident that may occur during the program.~ I understand that if my child becomes a discipline problem, he/she will be dismissed from the program.~ No money will be refunded.~ I also grant permission for the Recreation Staff to seek medical care for my child in the event that a family member cannot be reached.~ (All participants in any town recreation program must complete this waiver.)
Signature: _____________________________________________________Date:_____________________
Please initial if pictures taken of~ any listed participant during a recreation program may be displayed _______

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