BARNEGAT TOWNSHIP RECREATION

900 W Bay Ave Barnegat, New Jersey 08008 (609) 698-0080 x122,130 Fax: (609) 698-1302

Email: jbroadbent@barnegat.net

Indoor Tennis Camp

Instructor – Sue Rogers

Make checks payable to Barnegat Township and mail to the address listed above

Saturday’s

This All-inclusive Co-Ed 7-session Indoor Tennis camp is designed for children grades K-3 in the Cecil S. Collins School gym. Must bring own tennis racquet and a beverage. Wear Comfortable clothes and sneakers.

Dates: November 15, 22, December 6, 13, 20, January 10, 17.

Code # Tennis 103	930-1030 am	$53

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PLEASE PRINT ALL INFORMATION AND GIVE COMPLETE ADDRESS	FALL TENNIS CAMP

______ #Tennis 103

Child’s name_____________________________ Grade__________

Mailing Address_____________________________________________________________

Guardian Names_____________________________________________________________

Home Telephone_______________________________Cell #_________________________

Email address_______________________________________________________________

Emergency Contact_____________________________Telephone #___________________

Any Physical Restrictions or Allergies? Please list_____________________________________________________

_____________________________________________________________________________________________

I need a reasonable modification because of disability to enjoy this program. Y N

Barnegat Recreation believes the benefits of recreation should be made available to all people, including people with disabilities. Our staff fully understands the Americans with Disabilities Act & we invite participation by people with disabilities. Your open communication with us helps us better serve your child. Every resident of Barnegat Township can enjoy the Benefits of Recreation in our programs & services. Call 698-0080 x122, 130 or email jbroadbent@barnegat.net

Please READ/SIGN________________________________has my permission to participate in all the activities of the above registered program. In case of emergency, I authorize the programs assigned personnel to administer emergency first aid treatment, transport the participant to the hospital if necessary, and to notify me as quickly as possible. I understand that proper supervision is provided for all programs. However, in the event of an emergency due to accidents beyond their control, I hereby release the Barnegat Recreation Department, Barnegat Board of Education, sponsors, its supervisors, employees and program volunteers, from all liability.

HOLD HARMLESS AGREEMENT

The undersigned acknowledges that engaging in a sporting activity is potentially hazardous and could possibly result in a serious bodily injury to the participant. The undersigned further acknowledges and agrees that the Barnegat Township, Barnegat Board of Education, its officers, agents and employees do not undertake any responsibility, nor shall they be responsible for the personal safety of the participant, or the property of the participant at any time while going to, coming from, or engaging in the activity. The undersigned participant (and his parent or guardian undersigned, if the participant is a minor) for himself, herself, or the heirs, administrators, and executors do hereby agree, intending to be legally bound hereby, that the undersigned and anyone acting under them or through them, shall and by these presents do indemnify, hold harmless and excuse the Barnegat Township, Barnegat Board of Education, its officers, agents, sponsors and employees from any and all expense, cost, charges, bills, claims, damages, lawsuits, and liability for bodily harm or injury, or property damage which maybe suffered by participant or caused by the participant to any other person or entity during the course of the activity, or as a result of the activity.

SIGNATURE________________________________(if minor, Parent or Guardian) Date____________