Fill - Free fillable Camp Registration Forms 2020 Finalpdf (Town of Bristol) PDF form

2020

Camp Poppasquaw Registration Packet

BRISTOL RESIDENTS ONLY

Please Read

Where you can register your child for Camp Poppasquaw

• Camp registration packets available for pick up outside at the Quinta-Gamelin Community Center

(101 Asylum Rd.)

• On the Town of Bristol Parks & Recreation webpage:

http://www.bristolri.gov/154/Parks-

Recreation (needs to be completed and emailed to camp@bristolri.gov (camper’s name in the

subject line)

Registrations Must Have

• 2 PROOFS OF RESIDENCY (utility bills, most recent tax bill, etc.)

BIRTH CERTIFICATE (if 1

year at Camp Poppasquaw)

o Attach copies to completed registration packets

o Email or Text images of proofs of residency and birth certificate to camp@bristolri.gov

(Must put your camper’s name in the subject line)

• Camp Fee (Checks or Credit Card ONLY)

o Checks (made out to Bristol Parks & Recreation)

o Credit Card (by phone only, Please call 253-1611 from 8am-5pm)

• ALL Forms and Waivers must be complete and legible

• Registrations are not considered complete until all requested forms and payment in full has been

received.

How to submit your Camp Registration

• Paper registration forms, waivers, proofs of residency, birth certificate (if 1

yr) and full payment

can be left in the secure drop box outside of the Quinta-Gamelin Community Center (101 Asylum

Rd.) during and after office hours.

• Email online registration forms and waivers located at

http://www.bristolri.gov/154/Parks-

Recreation to camp@bristolri.gov (Must put your camper’s name in the subject line). You will

also need to email or drop off your proofs of residency and birth certificate at the Community

Center or the

camp@bristolri.gov address.

Disclaimers

• Incomplete submissions will be automatically rejected. The Town reserves the right to grant

exception of this policy on a case by case basis.

• The Town will dismiss a child from Camp Poppasquaw with forfeiture of payment if it is

determined at a later date that any information provided on the registration form was misleading

or falsified.

• The Bristol Parks & Recreation Department reserves the right to close out the camp registrations

before or after the June 19

deadline.

• Town, State and CDC Guidelines will be followed at Camp Poppasquaw

• Camp Poppasquaw Calendar, Parent Handbooks, Drop-off/ Pick-Up Locations and any additional

information will be sent out prior to the start of Camp on July 7

• Lunch included with fee. No bussing available for Camp.

Please call us with any questions 401-253-1611

TOWN OF BRISTOL

2020 CAMP POPPASQUAW REGISTRATION FORM

REGISTRATION DEADLINE IS JUNE 19, 2020

Camp Starts July 7, 2020 Camp Ends August 7, 2020

Please fill out each line. If not applicable, write ‘N/A’. CHILD MUST BE 7-14yo Bristol Resident

Registration Fee: $200 Shirt Size:

NEW Camp Location (Must Choose 1) Town Beach & Sports Complex Town Common

Child’s Name: Gender:

Last First Middle Initial

Date of Birth: Swimming Skills: School:

Eye Color: Hair Color: Height: Weight:

Child’s Primary Address:

Street Town State Zip

Last Name

First Name

Cell Phone

Home Phone

Work Phone

Mother

Father

Brothers/Sisters also in Camp (Names/Ages):

Emotional/Behavioral Issues:

Medications (medications are not dispensed by staff)

Food Allergies: Allergies:

Other Important Health Information:

Other Information that we should know about:

In an Emergency, Notify (if other than parent):

1. Name: Relationship:

Address: Phone:

2. Name: Relationship:

Address: Phone:

In case of an Emergency: Health Insurance Carrier: Policy #:

I understand every effort will be made to contact parents/guardians or campers. In the event that I cannot be

reached, I hereby give my permission for the following: The Camp Director may secure proper treatment which

may include hospitalization and x-rays if deemed medically necessary by him/her for my child.

Parent/Guardian: X Date:

Photographs/Publicity:

I hereby give permission for photos of the above enrolled child to be used for publicity purposes, public relations

and/or camp promotion materials.

Parent/Guardian: X Date:

Photographs/Publicity:

I realize injuries can occur from participation in sports and other activities. I hereby waive, release, absolve,

indemnify and agree to hold harmless the Town of Bristol, Department of Parks & Recreation, their Directors,

Instructors or Assignee from any claim arising out of injury to my child or myself.

Parent/Guardian: X Date:

Office Use Only

Date:___________

Staff:___________

Paid:___________

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CAMP POPPASQUAW PICK UP AUTHORIZATION FORM

Child’s Name:___________________________________

List up to (5) people who are authorized to pick up your child from camp

Last Name

First Name

Relationship

Cell Phone

Home Phone

Work Phone

Note:

• Person picking up your child must present a state issued driver’s license or photo

identification card before the child is released from camp

• Only the persons listed above will be able to pick your child up from camp.

• Person picking up your child must remain in their vehicle at the designated pick up

location (you will receive designated drop-off/pick-up locations in your Parent

Handbook prior to the start of the camp season).

• If the child is being picked up before the end of the camp day, please call our office at

401-253-1611 to alert our staff of the early pick up.

I have read and understand all of the above

_______________________________ ___________________________ ____________

Parent’s Signature Print Name Date

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TOWN OF BRISTOL – ASSUMPTION OF THE RISK AND WAIVER OF LIABILITY

RELATING TO CORONAVIRUS/COVID-19

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World

Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from

person-to-person contact. As a result, federal, state, and local governments and federal and state

health agencies recommend social distancing and have, in many locations, prohibited the

congregation of groups of people.

The Town of Bristol Parks & Recreation Department (“the Town”) has put in place preventative

measures to reduce the spread of COVID-19; however, the Department cannot guarantee that

you or your child(ren) will not become infected with COVID-19. Further, participating in

programs offered by the Town could increase your risk and your child(ren)’s risk of contracting

COVID-19.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily

assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by

participating in programs offered by the Town and that such exposure or infection may result in

personal injury, illness, permanent disability, and death. I understand that the risk of becoming

exposed to or infected by COVID-19 in the course of participating in programs offered by the

Town may result from the actions, omissions, or negligence of myself and others, including, but

not limited to, Town employees, volunteers, and program participants and their families. I

voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury

to my child(ren) or myself (including, but not limited to, personal injury, disability, and death),

illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may

experience or incur in connection with my child(ren)’s attendance at Town facilities or

participation in Town programming (“Claims”). On my behalf, and on behalf of my children, I

hereby release, covenant not to sue, discharge, and hold harmless the Town, its employees,

agents, and representatives, of and from the Claims, including all liabilities, claims, actions,

damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree

that this release includes any Claims based on the actions, omissions, or negligence of the Town,

its employees, agents, and representatives, whether a COVID-19 infection occurs before, during,

or after participation in any Town program.

__________________________________________________________________________

Signature of Parent/Guardian Date

__________________________________________________________________________

Print Name of Parent/Guardian Name of Participant(s)

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