2017 Stafford Summer Recreation Registration Form
Hello! Please fill out this form for each child you will be registering. We are looking forward to a great, fun-filled summer!!
Name of child:
Home Phone Number:
Mother's Work/Cell Phone:
Father's Work/Cell Phone:
Babysitter's Phone Number:
In case of emergency, and mother/father/babysitter cannot be reached, who should we contact?
Relationship to child (back-up emergency contact):
Phone Number (back-up emergency contact):
Please list any allergies, health conditions, medications, or other information that we should be aware of regarding your child:
Who has permission to pick-up your child? Please list names.
Do we have your permission for your child's photograph to be displayed on the Town's website regarding the Recreation Program?
Yes, you may post a photo of my child to the Town's website.
No, please do not post any photos of my child.
This summer, we are focusing on physical activity and active play! How would you rate your child's current level of physical activity?
Stationary - not physically active at all
Extremely active - my child loves physical activity!
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