2009 Ewing Day Camp Registration Form

2009 REGISTRATION FORM BOYS & GIRLS GRADES 1-7 This is a full day camp program for children entering grades 1-7. A pre-camp will run from June 22 through 26, 2009. The Camp will then run from June 29-August 21, 2009. Post camp sessions will be available for the weeks of August 24-September 4, 2009. Camp hours will be from 8:30 am to 4:30 pm. Pre-camp hours will be available from 7:30 am to 8:15 am and after camp hours runs from 4:30 pm to 6:00 daily. Unless noted on the schedule or other camp documents, all camp activities will take place at the Ewing Senior Community Center, 999 Lower Ferry Road, Ewing New Jersey 08628. Camp will be divided into weekly sessions.

Cost is $175 per week, per camper for Ewing Residents and $300 per week, per camper for non-residents. Registration Deadline: May 1, 2009 Registration: Campers must be registered for a minimum of one week of camp. Forms may be obtained online at www.ewingtwp.net. Completed forms will be accepted at the Ewing Recreation Department at 999 Lower Ferry Road, Ewing NJ. Office hours are 9:30 am to 4:30 pm. Completed forms can be mailed to the Recreation Department, 999 Lower Ferry Road, Ewing NJ 08628. Staff: Camp Director is Ron Schwartz. Ron has worked at this camp location for almost 30 years with the former JCC. He is a Ewing Resident and teaches in the Bordentown Regional School District. Other staff members include teachers, college students and high school students. Camper Information: Grade entering in 9/09 _________________________________ First Name: ____________________________________________

Date: _______________________________

Last Name: _____________________________________________

PRINT NAME CLEARLY

Address: _____________________________________________________ City __________________ State __________ Zip____________ School - 9/09 _________________________________________________________ Gender _______________ Shirt Size ______________ Special Needs child __________ Yes

__________ No

If yes__________________________________________________________

Parent or Guardian Information_______________________________________________________________________________________ Phone (home) _____________________________ (cell) ___________________________ e-mail ___________________________________ Your child must be picked up from camp or after-camp. Please list people responsible for picking up your child, including parents and siblings. 1 ____________________________________ 2. ___________________________________ 3 ____________________________________ PLEASE CHECK ALL WEEKS CAMPER WILL BE ATTENDING CAMP. NON-RESIDENTS - $300/WEEK PRE-CAMP $20wk Res. / $35wk Non Res. POST CAMP -$30wk Res. / $45wk Non Res. *pls. mark Pre, Post or both on the line __________ Pre-Camp 6/22-6/26 __________Pre-Camp 6/22-6/26 __________Pre-Camp June 22-June 26 __________ Week #1 6/29-7/3 __________Week #1 6/29-7/3 __________Week #1 6/29-7/3 __________ Week #2 7/6-7/10 __________Week #2 7/6-7/10 __________Week #2 7/6-7/10 __________ Week #3 7/13-7/17 __________Week #3 7/13-7/17 __________Week #3 7/13-7/17 ___________Week #4 7/20-7/24 __________ Week #4 7/20-7/24 __________ Week #4 7/20-7/24 ___________Week #5 7/27-7/31 __________ Week #5 7/27-7/31 __________ Week #5 7/27-7/31 ___________Week #6 8/3-8/7 ___________Week #6 8/3-8/7 ___________Week #6 8/3-8/7 ___________Week #7 8/10-8/14 ___________Week #7 8/10-8/14 ___________Week #7 8/10-8/14 ___________Week #8 8/17-8/21 ___________Week #8 8/17-8/21 ___________Week #8 8/17-8/21 ___________Post-Camp Week #1 8/24-28 ___________Post-Camp Week #1 8/24-28 ___________Post-Camp Week #1 8/24-28 ___________Post-Camp Week #2 8/31-9/4 ___________Post-Camp Week #2 8/31-9/4 ___________Post-Camp Week #2 8/31-9/4 RESIDENTS - $175/WEEK

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Make checks payable to “EWING RECREATION DEPARTMENT”

Amount Paid: $_____________________________

Cash: $___________________

Check # _____________________

Full ____________

Received by: ________________________________

Date _____________________

Receipt # ____________________

Partial __________

Credit Card _________________________________

Exp Date _________________

Card #__________________________________________

ACKNOWLEDGMENT OF RISK Program: Ewing Recreation Day Camp, Pre-Camp and After-Care I am aware that participating in this activity can be dangerous and involves risk of injury. I realize that participation in the above-mentioned activity presents risk, which includes minor or serious injury to any part of the body. These injuries could lead to temporary or permanent disability or even death. While the possibility of serious injury to participants is unlikely, it is important that all participants and parents realize that these risks do exist.

PARENT/GUARDIAN AGREEMENT I also recognize and acknowledge that there are certain risks of physical injury inherent in the named minor’s participation in this program. I have received, read and understand the risks and have discussed them with my child. He/she understands that he/she must obey all rules and regulations follow all safety procedures and obey any and all instructors, assistant instructors and staff members assigned to the program. My child and I understand the risk associated with this program, and my child and I agreed to accept our responsibility in making this program a safe one. I certify that the minor is in proper physical condition for safe participation in the Ewing Recreation Summer Camp and I agree that it is incumbent upon me to immediately inform the Ewing Recreation Day Camp Director should the minor’s physical condition change at any time prior to or during his/her participation in the program. I expressly agree that this agreement is intended to be as broad and inclusive as permitted by the Laws of the State of New Jersey and that if any portion of the agreement is held invalid, it is agreed that the balance shall continue in full legal force and effect and be valid. In consideration of the Ewing Recreation Department permitting the name minor to participate in the Recreation Department previously mentioned, the undersigned, being the parent(s) or legal guardian of ____________________________________________________ hereby waive and relinquish all claims I (we) may have as a result of said minor participating in the program against the Ewing Township Recreation Commission, Ewing Township Recreation Department and Ewing Township Mayor and Council, its offices, agents, servants and employees from any and all claims for injuries including death, damage or loss of property which may accrue to us on account of the minor’s participation in said program and we further agree to hold harmless the Ewing Township Recreation Commission, Ewing Recreation Department and Ewing Township Mayor and Council, its officers, agents, servants, and employees from any and all such claims.

Parent or Legal Guardian [indicate which]

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_________________________________________________ Date

_________________________________________________________________________________ PRINT NAME