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EWING RECREATION DAY CAMP

REGISTRATION FORM
BOYS & GIRLS GRADES Kindergarten-through Sixth Grade
This is a full day camp program for children entering grades Kindergarten through 6th grade. A pre-camp will run from June 21-25, 2010. The
Camp will then run from June 28-August 20, 2010. Post camp session will be available for the week of August 23-27, 2010. Camp hours will be
from 8:30 am to 4:30 pm. Pre-camp hours will be available from 7:30 am to 8:15 am and after camp hours runs from 4:30 pm to 6:00 pm daily.
Unless noted on the schedule or other camp documents, all camp activities will take place at the Ewing Senior Community Center, 999 Lower Ferry
Road, Ewing New Jersey 08628. Camp will be divided into weekly sessions. Cost for Pre and Post Camp is $200. Week #3 cost is $180 due to
Holiday (July 5th). Cost for weeks #1, 3, 4, 5, 6, 7 and 8 is $210 per week, per camper for Ewing Residents and $325 per week, per camper
for non-residents. The cost of all trips is included in the weekly tuition. If you have any questions, please call 609/883-1776.

 Registration: Campers must be registered for a minimum of one week of camp. Forms may be obtained online at
www.ewingnj.org Completed forms will be accepted at the Ewing Recreation Department at 999 Lower Ferry Road, Ewing
NJ. Office hours are 9:30 am to 4:30 pm. Completed forms can be mailed to the Recreation Department, 999 Lower Ferry
Road, Ewing NJ 08628. Deposit is $210.00 (one full week of camp). Campers MUST sign up for full weeks of camp.
Partial week or daily rates are discontinued.
 Late Registration: Registration after June 7th will be charged an additional $20/week late fee and will only be accepted
if there is an opening. Registration & payment must be received at least one week in advance of your child
participating in camp.
 Registration Deadline: June 7, 2010
 Staff: Camp Director is Ron Schwartz. Ron has worked at this camp location for almost 30 years with the former JCC. He is
a Ewing resident and teaches in the Bordentown Regional School District. Other staff members include teachers, college
students and high school students.

Camper Information: Grade entering in 9/10 ________________________ Shirt Size: ___________________________

SPECIFY ADULT OR CHILD
Name:__________________________________________________________Date:________________________________________
PRINT NAME CLEARLY
Address:_________________________________________________City____________________State_________Zip:____________

School:9/10_______________________________________________________________________ Gender ____________________

NAME OF SCHOOL
Is child in Special Education class? Yes____No____If yes, explain: _____________________________________________________

Parent or Guardian:____________________________________________________________________________________________
PRINT NAME CLEARLY
Phone:(home)____________________________(cell)_____________________________e-mail______________________________

Your child must be picked up from camp or after-camp. Please list people responsible for picking up your child, including parents and siblings.

1___________________________________________________________________________________________________________

2___________________________________________________________________________________________________________

3___________________________________________________________________________________________________________
PLEASE CHECK ALL WEEKS CAMPER WILL BE ATTENDING CAMP

RESIDENTS - $210/WEEK NON-RESIDENTS - $325/WEEK

___________ Pre-Camp June 21-June 25, 2010 __________ Pre-Camp June 21-June 25, 2010
___________ Week #1 June 28-Jul 2, 2010 __________ Week #1 June 28-July 2, 2010
___________ Week #2 July 6-July 19, 2010 __________ Week #2 July 6-July 9, 2010
___________ Week #3 July 12-July 16, 2010 __________ Week #3 July 12-July 16, 2010
___________ Week #4 July 19-July 23, 2010 __________ Week #4 July 19-July 23, 2010
___________ Week #5 July 26-July 30, 2010 __________ Week #5 July 26-July30, 2010
___________ Week #6 August 2-August 6, 2010 __________ Week #6 August 2-August 6, 2010
___________ Week #7 August 9-August 13, 2010 __________ Week #7 August 9-August 13, 2010
___________ Week #8 August 16-August 20, 2010 __________ Week #8 August 16-August 20, 2010
___________ Post-Camp Week #1 August 23-27, 2010 __________ Post-Camp Week #1 August 23-27, 2010
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OFFICE USE ONLY Make checks payable to “EWING RECREATION DEPARTMENT”
Amount Paid: $______________________ Cash: $_________________ Check # __________________ Full ______________

Received by: _______________________ Date: __________________ Receipt # _________________ Partial ____________

 ACKNOWLEDGMENT OF RISK
Program: Ewing Recreation Day Camp, Pre-Camp and After-Care

I am aware that participating in this activity can be dangerous and involves risk of injury. I realize that
participation in the above-mentioned activity presents risk, which includes minor or serious injury to any part of
the body. These injuries could lead to temporary or permanent disability or even death.

While the possibility of serious injury to participants is unlikely, it is important that all participants and
parents realize that these risks do exist.

PARENT/GUARDIAN AGREEMENT
I also recognize and acknowledge that there are certain risks of physical injury inherent in the named
minor’s participation in this program. I have received, read and understand the risks and have discussed them
with my child. He/she understands that he/she must obey all rules and regulations follow all safety procedures
and obey any and all instructors, assistant instructors and staff members assigned to the program. My child and
I understand the risk associated with this program, and my child and I agreed to accept our responsibility in
making this program a safe one.

I certify that the minor is in proper physical condition for safe participation in the Ewing Recreation
Summer Camp and I agree that it is incumbent upon me to immediately inform the Ewing Recreation Day
Camp Director should the minor’s physical condition change at any time prior to or during his/her participation
in the program.

I expressly agree that this agreement is intended to be as broad and inclusive as permitted by the Laws
of the State of New Jersey and that if any portion of the agreement is held invalid, it is agreed that the balance
shall continue in full legal force and effect and be valid.

In consideration of the Ewing Recreation Department permitting the name minor to participate in the
Recreation Department previously mentioned, the undersigned, being the parent(s) or legal guardian of
____________________________________________________ hereby waive and relinquish all claims I (we)
may have as a result of said minor participating in the program against the Ewing Township Recreation
Commission, Ewing Township Recreation Department and Ewing Township Mayor and Council, its offices,
agents, servants and employees from any and all claims for injuries including death, damage or loss of property
which may accrue to us on account of the minor’s participation in said program and we further agree to hold
harmless the Ewing Township Recreation Commission, Ewing Recreation Department and Ewing Township
Mayor and Council, its officers, agents, servants, and employees from any and all such claims.

PARENT OR LEGAL GUARDIAN (indicate which)____________________________________________

PRINT NAME: ____________________________________________________________________________

SIGNATURE:_____________________________________________________________________________

DATE: ________________________________________________________