Summer Rec Registration

Summer Rec Program

Please fill out the following form for each child attending Summer Rec and submit.

Child’s Name

Child's Name

First

Last

Age

Parent/Guardian Name

First

Last

Parent/Guardian Phone

Emergency Contact

Emergency Phone Number

Allergies

For end of camp my child will be:

Picked up

Walking

If picked up, who will be picking up child?

Please list any additional people who have permission to pick up:

Will your child go home for lunch?

Yes

Is your child allowed to walk in a group without a chaperone on all day field trips?

Yes

Depends on the trip

https://villageofelba.com/village-of-elba-waiver-release-of-liability/

I have read and agree to the Waiver and Release of Liability

I Agree

I Do Not Agree

Printing your name here will serve as signature and your agreement to the Waiver of Liability for Village of Elba Summer Rec

If you are human, leave this field blank.