Easton Parks & Recreation
Registration Form

Please complete this form, print it out, and then mail it in with payment.

Activity:
Session:
Name:
Address:
City,State, Zip:
Teacher's Name:
Email:

Fee:
Age: Grade:
Male Female
Birthdate:
Home Phone:
School:
Room:
Education Connection: Yes

(Children Only)

Parent
Name
Work Phone
Cell Phone
Beeper
Mother
Father

Who is responsible for picking up the child? All pick-ups need to be done promptly.
Name: Phone:

In case of emergency, please contact:
Name: Phone:
Physician's Name: Phone:
Hospital Choice: #1 #2
Any Medical Problems:
Allergies:
Special Needs:

While enrolled in the above activities sponsored by the Easton Parks & Recreation Commission, the Town of Easton and the Park and Recreation Director and the Staff are not responsible for any injuries which may occur while participating in or traveling to or from any of the activities. I also realize and assume the risk of challenging activities I may participate in. In the event of an injury permission is also granted to see to it that proper first aid and medical attention is given.

Signature (of parent or guardian): Date:

Permission Slip for attending Afterschool Programs
Child's Name:
Activity: Dates of Activity:
Day of Activity: Time of Activity:
Teacher's Name: Room:

My child has permission to attend the above activity sponsored by the Easton Parks & Recreation Department.

Signature (of parent or guardian): Date: