If you are registering a child
for one (1) week of Summer
Festival, payment is due in full
at time of registration.
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If you are registering a child
for multiple weeks of Summer
Festival, a minimum deposit of
$100.00 per child is due with
registration and full payment is
due no later than May 27, 2016
Again this year, we will offer registration forms on line!
To register for Summer Festival 2016,
Plea print the following forms.
Each family will need:
Page 1 (Summer Festival Registration) (1) per family
Page 2 (1) for each child
Page 3 (Extended Day) (1) per family(if needed)
Plea enclo a copy of a current utility bill if your family is
a NEW Summer Festival Participant to verify Taunton residency.
Forms received without payment will not be procesd.
Openings in Summer Festival are on a first come, first rved basis.
For confirmation on enrollment, plea clearly print your e-mail address.
If you have any questions or concerns, plea e-mail:
**********************
Mail completed forms along with check or money order to
公共管理理论Summer Festival
170 Harris Street
Taunton, MA 02780
After initial deposit is made, you will be nt information to pay any balance due on line by check or
credit card using the City of Taunton’s cure site.
Summer Festival Registration - 2016
Child’s Name:__________________________ Date of Birth: _____________Age:___
Child’s Name:__________________________ Date of Birth: _____________Age:___
Child’s Name:__________________________ Date of Birth: _____________Age:___
E-Mail Address: (plea print clearly) _____________________________________________________________ Mailing Address:_____
________________________ City:______________ Zip: ________ Home Phone Number:_____________________ Cell Phone: _______________________
Parent Information:
(Father’s Name)__________________________Day Time Phone Number:_________________________ (Mother’s Name)_________________________Day Time Phone Number:_________________________ Emergency Name And Number of Someone Who Will Be Allowed to Pick up Your Child
In the Event A Parent Cannot Be Reached:
Name: __________________________________Relationship to Child/ren:_________________________ Address:_________________________City:_______________Phone:_____________________________
************************************************************************************* You must provide transportation to and from Hopewell Park. Plea list any individual in addition to
tho named above that will be allowed to pick up your child/ren.
Name Relationship Phone Number
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________ Children will not be allowed to leave with anyone not listed above without written authorization of a parent/legal guardian.
I give my child/ren named above permission to participate in the 2016 Summer Festival Program sponsored by the City of Taunton and do hereby connt to his/her participating in recreational programs and do forever RELEASE, acquit, discharge,
and covenant to hold harmless the City of Taunton from any and all actions, caus of action, [and] claims on account of, or in
any way growing out of, directly or indirectly, all known and unknown personal injuries or property damage which I may now
or hereafter have as the parent/legal guardian of said minor, and also all claims or right of action for damages which said
minor has or hereafter may acquire, either before or after he/she has reached his/her majority resulting from his/her
participating in the City of Taunton’s Recrea tional Program.
Photography Connt
It is possible that pictures may be taken during programs. I grant permission for pictures taken during program hours to potentially be ud for promotional purpos - (newspaper, website, flyers, facebook,etc) If NOT state NO here: ________
I understand that if my child is not picked up by 3:30 PM SHARP, (5:15 PM if enrolled in extended hours) I will
be charged a $15 late fee per child payable to the City of Taunton. If this should happen more than once, the
result could be termination from the program and no fees will be refunded.
Signed:________________________________________
Relationship to Participant: _________________________ (Must be Parent or Legal Guardian)
Summer Festival Registration - 2016
Child’s Nam e: _____________________________ Age:_____ Preferred Name: ___________________________
School Attended: ______________________ Grade Completed (June 2016)__________
1.Does your child have any physical limitations, conditions, or allergies that we should be
写委托书
aware of? If so, plea indicate below, or state NONE.
_____________________________________________________________________________________ 2. Is your child currently taking any medication? If so, plea indicate the name of
medication and reason below or state NONE.
_____________________________________________________________________________________
Plea Note: We are not allowed to administer any medication while your child is enrolled.
3.Is your child in a Special Education Program at school? Is a 1:1 aide required at
school? Any problems or issues with hearing/speech/behavior?
不加思索
_____________________________________________________________________________________
** On Full Day Trips the Summer Festival will be open only to tho who will participate in the weekly trip. No additional fees will be charged for the trips.
Extended Hours - Will your child require early drop off (before 8:30 AM) or late pick-up
(after 3:30 PM) ______ NO ______ YES plea complete Extended Day Application
T-Shirt Size: Youth _____ (Small 6-8, Medium 10-12, Large 14-16)
Adult _____ (Small 34-36, Medium 38-40, Large 42-44, X-Large 46-48)
************************************************************************************* Plea indicate weeks enrolling in:
_____(#1) June 27 – July 1 _____(#2) July 5 - 8 _____(#3) July 11 - 15 _____(#4) July 18 - 22 Legoland Plymouth Cruis Movies & Caroul Colt State Park
太阳天蝎
(No Program July 4th)
_____(#5) July 25 – 29 _____(#6) Aug. 1 – 5 _____(#7) Aug. 8 – 12 _____(#8) Aug. 15 – 19
NE Aquarium Water Wizz Paw Sox Game Canobie Lake Park
***************************************************************************************** Office U:
Total Due: ____________
Amt Paid @ Registration:___________ Ck# & Name ___________________
Balance Due:__________ 2nd Payment: ____________ Ck# __________ Paid in Full
MOCD
Summer Festival 2016
普通话资料Extended Day
Child’s Name _______________________________________Age ____________ * Extended day hours do not begin until 6:45 AM and end at 5:15 PM sharp. *
Fee Schedule:
AM Only (6:45 am - 8:30 am) $25.00 Per Child Per Week (or $7.00 a day)
PM Only (3:30 pm - 5:15 pm) $30.00 Per Child Per Week (or $8.00 a day)
Both AM & PM $40.00 Per Child Per Week (or $10.00 a day)
My child will be enrolled in: Plea check week and circle AM and/or PM, and weekly or daily
____ Week #1 (June 27 – July 1) ____ Week #2 (July 5 - 8) ____ Week #3 (July 11 - 15)
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AM PM AM PM AM PM
Full Week Full Week Full Week
Daily: M T W Th F Daily: M T W Th F Daily: M T W Th F
欧洲古典音乐
____ Week #4 (July 18 - 22) ____ Week #5 (July 25 – 29) ____ Week #6 (Aug. 1 - 5)
AM PM AM PM AM PM
Full Week Full Week Full Week
Daily: M T W Th F Daily: M T W Th F Daily: M T W Th F
____ Week #7 (Aug. 8 – 12) ____ Week #8 (Aug. 15 - 19)
AM PM AM PM
Full Week Full Week Daily: M T W Th F Daily: M T W Th F
Expected Drop-Off Time _________
Expected Pick-Up Time _________
I understand that if my child is enrolled in extended pm care and is not picked up by 5:15 PM sharp, I will be charged a late fee of $15.00 per child and that if this should happen more than once, the result could be termination from Summer Festival and no fees will be refunded.
X___________________________________ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Office U Only:
Total Due:_________ Amt. Paid __________ Ck # & Name ______________________
