TOWN OF WILTON

PARKS AND RECREATION

SUMMER CAMPS

PROGRAM___________________

DATE OF BIRTH___/___/_____

NAME______________________________________ AGE______ GRADE________

MAILING ADDRESS___________________________________PHONE____________

I /We the parent/guardian of the named boy/ girl, do hereby give approval to his/ her participation in any and all activities of the Wilton Recreation Department. Program listed above for the current season. I/ We do further release, absolve, indemnify and hold harmless, waiving all claims against the Wilton Parks and Recreation Commission, the Director, the Organizer, and the Supervisors appointed, any and all of them. In case of injury to my son/ daughter, I/ WE hereby waive all claims against the Wilton Parks and Recreation Commission, the Director, the Organizer, and any of the Supervisors appointed, also included is when riding on the bus to or from these activities. The Recreation Department reserves the right to decide player eligibility based on inappropriate behavior.

I/We understand that the Wilton Recreation Department does not carry any accident insurance.

I/We will provide any insurance that we deem necessary for our child.

Parent/Guardian

Please check all that apply: Grades Time Date

$ 15____ Lacrosse 5-8 ** Will be held only if enough interest**

$ 20 ____ Co-Ed Soccer 1-6 6-7:30 pm 8/23-26

$ 20 ____ Girls Basketball 3-7 11:30 am-1:30 pm 7/26-29

$ 20 ____ Boys Basketball 3-7 9-11 am 7/26-29

$20 ----- Field Hockey 3-7 4:30-6 pm 8/16-8/19

$ 15 ____ Arts & Crafts ages 5-12 5-8 olds 10-11 am

9-12 olds 11:15-12:15

*For out of town participants please add $5.00 to the price listed*