Outdoor Adventure Program
REGISTRATION FORM ~ Year 2012

Week Of: ___/___ - ___/___  Session #_____

Youth Name Age                      DOB
Youth Name Age                      DOB
Youth Name Age                      DOB
Address State                                          Zip
City Cell Ph#
Home Ph#  
Email Address @
Emergency Contact Emergency Ph#
 
Allergies:
_______Grafton Summer Clinic $200 per youth
(After June 18th 2012)
Early bird discount (-$15) if registered by June 18th
per youth  ________
(minimum age 6 years old Aug 1st 2012)
DATES (Mon- Thurs)
Session #1 June 25th - 28th     __________
Session #2 July 16th - 19th       __________
Session #4 August 6th - 9th      __________
Session #5 August 13th - 16th  _________
Session #6 August 20th - 23rd   __________
 

_______High Adventure Summer Clinic $200 per youth
Early bird discount (-$15) if registered by June 18th
Additional fees for field trip to be determined
(minimum age 12 years old by 12/31/2012)
2 Session only  #5 or 6
Aug 13th - 16th _________
Aug 20th - 23rd _________

$200 wk = Due $_____________

Deduction -$15 ___________if registered by June 18th



 





High Adventure Clinic
$200 wk = Due $_________________
Deduction -$15 ___________if registered by June 18th

 

Total amount due $____________
Location: Grafton Lions Club     
                

Required: Minimum 24 & Maximum of 65 youth per clinic
**Youth Outdoor Adventure T-shirts Available $10 ea
 please circle size(s) listed below:

Youth sizes:   Yth Med 10/12   or   Yth LG 14/16

Adult sizes:    Small,    Medium,     Large,    XLrg

T-Shirt Order
Qty_____x add $10  = ________

 

= TOTAL AMOUNT DUE $__________

Sorry No Refunds!

The Clinic will be held rain, snow, or shine. Unless a Major snow storm hits the area

Waiver Info see waiver sheet Must be signed off on: Have you read and agreed to it? YES_______

Parent Signature _________________________________________________________________________________________DATE______/______/20______

Make all checks payable to: FIN AND FEATHER SPORTS Mail to: PO BOX 314 Upton, MA 01568 ~ Sorry no credit cards!
 Pre-Registering is required
You will receive an email with a check list prior to the week chosen, We look forward to meeting you.
 ___________ YES, I would like to receive info on other Summer/Winter/Spring Youth Outdoor Programs
 

Registration Total $ ________Extended day Total $______ T-Shirt (s) Total $________ = Total Due $______________
 

[Office use/ payment received on: Date__________/20_____ Paid $______________By________________]

 

Fin & Feather Sports ~Outdoor Adventure Program

RELEASE AND MEDICAL CONSENT

Grafton Clinic

I, the parent/guardian of the person named on this form, a minor (“the registrant”), agree that I and the registrant will abide by the rules and policies of the Grafton
Recreation Commission and its programs, including generally accepted standards of conduct, and understand that failure to adhere to such rules, policies, and standards
 may result in expulsion from the program without a refund.

________________
parent/guardian initials

I recognize that the registrant may suffer physical injury as a result of the registrant's participation in the program. Accordingly, in consideration for accepting the registrant
for participation in the program, on behalf of myself and the registrant, I hereby release, discharge, hold harmless, and indemnify the Town of Grafton and the Grafton
Recreation Commission, The Grafton Lions Club, Fin & Feather Sports of Upton, Inc., their affiliated organizations and sponsors and respective officers, directors,
employees, coaches, committees, and associated personnel, including, without limitation, the owners of the fields and facilities utilized for the program(s), of and from any
claims, demands, actions, causes of action, suits, and liability arising as a result of the registrant's participation in the program(s).

________________
parent/guardian initials

CONSENT FOR MEDICAL TREATMENT OF A MINOR. As the parent or legal guardian of the minor named on this form, I give my consent to seek, obtain, and provide
emergency medical treatment for such minor in case of injury that occurs while participating in Grafton Recreation Commission programs and related activities. This care may
be given under whatever conditions are necessary to preserve life, limb, or well-being of such minor. I understand that such treatment will be sought and provided only in an
emergency and that reasonable efforts will be made to contact me before providing such treatment.

x_______________________________________________________

Signature of Parent/Legal Guardian

Date ________________20_________

I have read and understood the Grafton Recreation Policy

x_______________________________________________________

Signature of Parent/Legal Guardian

Date _________________20________