SRC 2010 Spring Registration Form
Register by mail or in person Mon-Fri 9-4:30pm
at the Recreation Office, 25 West End Avenue.
Please print this page and return
to:
Somerville Recreation, PO Box 399, 25 West End Ave. Somerville,
NJ 08876
Name: ________________________________________________________________________
Email Address ____________________________________________
Address _______________________________________________________________________
City/Zip Code____________________________________________
Home Phone# ________________ Parent's Cell Phone #________________
Male _____ Female _____ Age _____ Grade _____ School ______________________
Shirt Size YL _____ AS _____ AM _____ AL _____ AXL ______
Medical Conditions (if any) Coaches/Instructors should know about:
________________________________________________________________________________
Interested in Coaching? Yes _____ No ______
Looking to Volunteer? Yes _____ No ______
In Case of Emergency call:
Name _____________________________________________ Relationship to registered __________________________________________________
Address ___________________________________________ Home # _____________________________ Cell # _____________________________
| Youth Soccer — $35/20 | Ken Cornell Wheelpark — $10 Residents / $40 Non-Residents | Men's Mayor League Softball — $675 per team |
| Boys' TBall — $30 | Grounds for Sculpture Trip —$25 | Annual Metric Century Ride — $20 |
| Girls' TBall Softball —$30 | Memorial Day Family Fun Ride —$25 Individual / $10 Family | Discount Movie Tickets — $8 |
| Girls Softball League —$45 | Memorial Day Youth Wheel Races - Non-Perishable Food donation | Living Memorials |
| Video Animation — $50 | Coaches Training Clinic — Free SRC Coaches / $30 Non-SRC | Party and Camping Tents: Party - $175 / Camping - $20 |
| Engineering Fun — $50 | Carol Pager Women's Softball - $575 per team | Volleyball Set — $20 w/$100 deposit |
| Chess Club — $10 | Men's National League Softball — $675 per team | Sports Equipment Bag — Free |
| Easter Egg Party 3/27 — Non-Perishable Food donation | Beekeeping Course — $50 | Wedding Picture Session — $25/$50 |
| Jessie Oakley Memorial Trout Fishing — $10 per team | Volunteers (Priceless! area of interest? _______________________) |
I give my consent for my child to participate in the Somerville Recreation activities checked above. I understand there are special dangers and risks in these activities, including serious injury and death. I assume all risk of injury, damage and liability arising from these activities for my child.
As their parent/guardian, I herewith authorize the treatment of above child/children by a qualified or licensed medical doctor in the event of a medical emergency which, in the opinion of the attending physician, may endanger his or her life, cause disfigurement, physical impairment or undue discomfort if delayed. This authority is granted only after reasonable effort has been made to reach me.
Parent's Signature: _________________________________________________ Date __________________
Somerville Recreation does provide secondary accident insurance for all programs listed on this website. This provides for $25 deductible for all adult programs and no deductible for youth programs and is subject to policy limits.
Somerville Recreation reserves the right to cancel, alter, supplement, limit registration or change any information on this brochure to best serve all involved.
For inclement weather cancellation information, call the Somerville Recreation Cancellation Number 908-725-2300 x1010.