Join your Friends For A Whole Lot Of Summer Fun!

Summer Recreation For Kindergarten through 8th Grade

Monday, July 1 - Friday, Aug. 9, 2019 No program on Thursday, July 4

AT SUMMER RECREATION CHILDREN WILL MAKE NEW FRIENDS, CONNECT WITH OLD FRIENDS, BUILD CHARACTER AND BEST OF ALL HAVE FUN!

ALL SUMMER CHILDREN WILL ENJOY THE GREAT OUTDOORS WITH SPORTS, CRAFTS, GAMES, AND WELLNESS ACTIVITIES.

DON’T FORGET WEEKLY THEMES AND ON SITE SPECIAL EVENTS

Registration Form and Flyer is available at the

Recreation Office or www.plainfieldct.org Plainfield Recreation 860-564-1819 Register early for the payment plan

SUMMER RECREATION PROGRAM See “How To” register below. WHO: Plainfield residents who have completed kindergarten thru 8th grade

WHAT: Daily sports, games, crafts, weekly

themes & weekly special events

TEENS! For students in 6th, 7th & 8th

grade special weekly trips are offered.

DATES: 6 Weeks- No program on Thursday, July 4

Monday, July 1 through Friday, August 9, 2019

WHERE: Plainfield Memorial School

FEES: $350 for whole program

TIME: 9:00am- 3:00pm

IMPORTANT: Busing will not be available this Summer (AM and PM) EXTENDED DAY PROGRAM: For an additional fee an extended program is available for late parent pick-up and early drop-off from 6:30-9:00am & 3:00pm-6:00pm. Fee is for all six weeks. This program is billed in two installments. You must register for this program in advance and pay first Installment with first program payment. Space is limited. 6:30-9:00AM $180 ($90 1st installment due by May 3rd balance $90 due June 3rd 3:00-6:00PM $180 ($90 1st installment due by May 3rd balance $90 due June 3rd

HOW TO REGISTER: REGISTRATION INFORMATION

Registration is on a first come, first served - basis. Space is limited per grade level and Teens Register early for the best payment plan. DO NOT RETURN FORM TO SCHOOLS A parent or legal guardian must complete a registration form and return it to the Recreation Office. Last day to register is when program is full or June 3rd which ever comes first. A child is registered when a completed registration form and non-refundable $50 deposit

per child is received in the Recreation Office. Deposit is deducted from final payment. 1/2 payment is due by May 3rd and final payment due by June 3rd. NO REFUNDS AFTER JUNE 3rd. No child will go on the roster without final payment by June 3rd. A WEEK PRIOR TO THE START OF PROGRAM A PARENTS PACKET WILL BE MAILED WITH

A CALENDAR OF ACTIVITIES AND OTHER IMPORTANT INFORMATION

All fees and programs are pending approval of annual Town Budget.

TEEN SPECIAL

Summer Recreation Registration Form Return Form (with appropriate fees) to: Plainfield Recreation 482 Norwich Road Plainfield 06374 DO NO RETURN FORM TO SCHOOL PLEASE COMPLETE BOTH SIDES OF REGISTRATION FORM

Child’s Name_________________________________________________________________Male_______Female________ Current Grade__________________School_______________________Date of Birth________________________ 2018-2019

Mailing Address______________________________________________________Town_______________________ Zip Code___________________Phone #_____________________________Parent cell#_______________________ Street Address (if different than mailing)______________________________________________________________ Child’s Mothers Full Name_________________________________________________________________________ Work Phone #________________________________Employer___________________________________________ Child’s Fathers Full Name_________________________________________________________________________ Work Phone #________________________________Employer_________________________________________ Step-Parents Full Name___________________________________________________________________________ Work Phone#________________________________Employer_________________________________________ Other than parents list individuals who have permission to pick-up your child and can be contacted in case of an emergency. These individuals should be available during the day and know they are on this list. 1.__________________________________________Relationship___________________Phone_________________ 2.__________________________________________Relationship___________________Phone_________________ 3.__________________________________________Relationship___________________Phone_________________ Copies of any court documents regarding custody of the child registered must be on file with the office and updated as appropriate. Are there any parental restrictions? yes______ no______ Please list any physical/mental limitations______________________________________________________________ Please list any medical problems_____________________________________________________________________ Please list any allergies Please list any medication your child is taking__________________________________________________________ Please list any special needs or concerns for your child that we should be aware of: ________________________________________________________________________________________________ If your child requires medication during the summer program they must be sent to the program by a parent with a signed medical authorization form. Sunscreen and bug spray requires a signed “non-prescription” authorization form.

Do not send medication to program with children.

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Child’s Name:___________________________________________________________________ Please Check: My child will attend on the following days: Mon____ Tue____ Wed ____ Thu____ Fri____ My child will be parent drop off at 9am _________ and parent pick up at 3:00pm _________ My child will attend the extended day program: AM_____PM____ (half payment due at registration) My child has permission to walk/ride or bike to and from program___________________________

Busing will not be available this Summer (AM and PM)

EMERGENCY RELEASE: I grant permission to the Town of Plainfield to utilize any medical emergency services it deems necessary to treat any injury that I or my child may incur. WAIVER: I understand that participation in any Town of Plainfield recreational programs and/or it’s related facility by myself or my minor child involves risks. I understand that participation in any recreational land or water sport/program or activity there is an ele-ment of risk, physical contact and strenuous physical activity in which each participant voluntarily assumes all risk. I affirm that my health is ade-quate and that I am not under any physician’s care that bears upon my (or my minor child’s) participation in the above activity. In consideration of being allowed to participate in town activities, I assume all risks, including personal injury and fatality, which may arise from participation of myself or my minor child in such activities. I agree for myself, my family, heirs, executors and administrators to not sue and to release, indemnify and hold harmless the Town of Plainfield and their affiliates, officers, directors, employees, volunteers, successors and assigns from any and all liability, claims, demands and causes of action whatsoever, that may arise from the participation of myself or my minor child in town sponsored activities and its various programs on or off-site, whether it results from the negligence of any of the above named persons or entities or from any other cause. This release and indemnification agreement shall be as broad and inclusive as is permitted by the law of the State of Connecticut. If any portion of it is held invalid, the balance shall continue in full force and effect. PHOTO RELEASE: I understand that for promotional purposes, the Town of Plainfield and local media takes photographs of participants enrolled in recreational activities, classes or programs. I hereby release and permit the Town of Plain-field to utilize for said promotional purposes any photographs of me or my minor child engaging in the above listed activities. TRANSPORTATION: I give permission for my to travel by bus and participate in any field trip scheduled with this program ________________________________________________________________________________________________ Parent/Guardian Signature Date

Fee Paid___________________ Receipt____________________ Date______________________ Fee Paid___________________ Receipt____________________ Date______________________ Fee Paid___________________ Receipt____________________ Date______________________ Fee Paid___________________ Receipt____________________ Date______________________

Check the appropriate box: K-5th Recreation (6 weeks) $350

6-8th Teen Recreation (6weeks) $350

AM Extended day

PM Extended day

Recreation single weeks $90 per week Check:__7/8-7/12__7/15-7/19__7/22-7/26__7/29-8/2

Deposits are non-refundable. Refunds will be given for payment (minus deposit ) up to June 3rd.

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