SRC 2008 Summer Registration Form
Register by mail or in person Mon-Fri 9-4:30pm:
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# ___________________________________ Cell Phone # ___________________________________________
Male _____ Female _____ Age _____ Grade _____ School _____________________________________________________
Shirt Size: YL _____ AS _____ AM _____ AL _____ AXL _____
Medical Conditions (if any) Coaches/Instructors should know about:
________________________________________________________________________________
In Case of Emergency Call:
Name _______________________________________________ Relationship to registered _____________________________
Address _________________________________________ Home# _____________________ Cell # ____________________
___ Fall Soccer - $35/$20 |
___ Bicycle Rodeo - Free | ___ Trip to Bronx Zoo - $74 |
| ___ Olympic Archery - $20 | ___ Girls' Softball Camp - $200 | Contact Travelers Choice (908) 534-4224 |
| ___ Water Awareness - $15 | (Contact Tony Catalano 732-322-6360) | ___ Wedding Photo Session - $10/20 |
| ___ Summer Basketball Night League - $15/$150 | ___ Memorial Day Family Fun Ride- $15/$25 | ___ Sports Bag Rental - Free |
| ___ Tennis Mini-Camp - $25 | ___ Memorial Day Youth Stock Races - Food donation | ___ Living Memorial - Fee TBD |
| ___ Learn to Swim at YMCA - $25 | ___ Working Man's Bicycle Stage Race - $30 per race | ___ Camping Tents - $15 ___ Party Tent - $175 |
| ___ Summer Reading - Free | ___ Discount Theme Park Tix | ___ Volleyball Set - $20 w/$100 deposit |
| ___ National Night Out - Free | Park ______________________ # Tickets _____________ | ___ Volunteer (priceless!) |
| ___ Parent/Child Beekeeping - $50 | ___ Discount Movie Tix - $7 | Area of Interest ______________________ |
| ___ Trip to Grounds for Sculpture - $20 |
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 (or Adult Participant's) Signature: _________________________________________________ Date __________________
Somerville Recreation provides secondary accident insurance
for all programs listed on this Registration Page.
This provides for a $25 deductible for all adult programs
and no deductible for youth programs (for all registered participants) and is
subject to policy limits.
Please note: Somerville Recreation reserves the right to cancel, alter, supplement programs, or to limit registration to best serve all involved.
For inclement weather cancellation information, please call the Somerville Recreation Cancellation Number 908-725-2300 x1010