Details for DEC VACATION CAMP
423310-A (Camps/Vacation Camps)

There are 2 sections of this class
Gender: Co-ed
Web Reg Available to:
NonResident: 10/15/2017 @ 12:00A - 12/19/2017 @ 12:00A
Resident: 10/15/2017 @ 12:00A - 12/19/2017 @ 12:00A
Ages: 6 years to 12 years
Open to These Grades: N/A
Dates\Days\Times\Locations:
Date Time Day Location
12/26/2017 - 12/29/2017 8:30A to 4:30P Tue, Wed, Thu, Fri
Potential Fees:
Applied On or After 11/11/1999: Fees: $168.00  (Required)
Applicable discounts not applied and Taxes included in price.
Details:
This popular and exciting camp combines both on and off ice activities. Daily activities include supervised skating time and off ice activities including games, crafts and more.


WEST HARTFORD HUMAN & LEISURE SERVICES- VETERANS MEMORIAL RINK
HEALTH AND INFORMATION FORM


YOU MUST COMPLETE AND SIGN THE FORM BELOW TO ENROLL YOUR CHILD.


PLEASE PRINT CLEARLY.
IN CASE OF AN EMERGENCY WE MUST BE ABLE TO READ THE INFORMATION


Program Name ___________________________________Program # ______________

Child's Name ____________________________________________________________

Address ______________________________________________________________

Mother's Name __________________________________________________________

Home Phone ______________________Work ______________ Cell _______________

Father's Name ___________________________________________________________

Home Phone _____________________ Work ______________Cell _______________

Does your child carry and epi-pen? ____Yes ____ No

Does your child have any known allergies or have any known illnesses or physical limitations, etc.

If so, please list and describe ________________________________________________

_______________________________________________________________________

List Medications __________________________________________________________

_______________________________________________________________________

Family Doctor's Name _________________________Phone: ______________________

Emergency Contact (Person to call if unable to contact parent):

Name ____________________________________Relationship ___________________

Home Phone _______________________Work _______________Cell ______________





PLEASE READ EACH STATEMENT BELOW AND IF YOU UNDERSTAND AND AGREE TO
EACH STATEMENT WRITE YOUR INITIALS IN THE SPACE NEXT TO THE PARAGRAPH TO
SIGNIFY YOUR UNDERSTANDING AND AGREEMENT.

______ In the event my child needs emergency hospital or medical care while participating in this West Hartford Leisure services Program and there is no time for me to be contacted and/or I cannot be reached, my hospital preference is: _____________________________________________________________

______ However, if circumstances are such that it is deemed necessary to admit elsewhere, permission is hereby granted.

______ In the event my child needs emergency medical care while in this West Hartford Leisure Services Program, I hereby give permission for the hospital to give such emergency treatment as is considered necessary or desirable by medical judgment, including administration of anesthesia.

______ In the event that my child needs to be transported by an ambulance, I give my permission for such transportation and I agree to assume all expenses incurred by said transportation.

______ I agree to assume all medical expenses incurred by my child while participating in this West Hartford Leisure Services Program.

______ I realize that as with any physical activity there is a possible risk of accidental injury to my child while participating in this West Hartford Leisure Services Program. I agree to assume the risk of any injury which my child might suffer while involved in the West Hartford Leisure Services Program and will not hold the Town of West Hartford or its instructors liable for any injuries which my child may suffer while participating in this West Hartford Leisure Services Program.

______ FIELD TRIPS: I hereby give my permission for my child to go on the field trips scheduled for his/her particular camp program. The exact schedule will be provided to me at the beginning of the camp session. If I do not wish my child to attend the field trip, I understand that I will need to make other arrangements for my child on that day.


Signature of Parent or Guardian: ____________________________________ Date _________________










RETURN TO:
Veterans Memorial Skating Rink
56 Buena Vista Road
West Hartford, CT 06107
or FAX to 860-521-1573










This popular and exciting camp combines both on and off ice activities. Daily activities include supervised skating time and off ice activities including games, crafts and more.