2. Child's Name
3. Date of Birth
5. Parent/Guardian Name
7. Address
9. Phone Number
11. Phone Number
13. Email Address
14. Add my email address to the Youth Program's email list to keep me informed.

    1. Yes
    2. No
16. What grade will your child be in next year?
18. Please list any allergies:
20. Does your child have any past or present medical history that we should be made aware of?
22. The following individuals are authorized to pick up my child in my absence:
24. Please read this section thoroughly and type your name below each release acknowledging your understanding of the release.
26. 
    
28. In consideration of the acceptance of my child's enrollment in all Town of Avon programs, I for myself, my child, my executors, administrators, and assignees, do hereby waive any and all rights and claims I may have against the Town of Avon, its personnel, instructors, or other individuals associated with the recreational program, for any and all injuries, disabilities or death suffered by my child as a result of participation in any recreational programs or activities conducted at or sponsored by the Avon Recreation Center. By typing my name below, I also authorize and consent to any emergency medical treatment rendered to myself or child under the general or special supervision, on the advise of any physician.
30. In the event that your child may require medical attention and that parent/guardian or alternate contact person's named on this application cannot be contacted, Avon Recreation Center officials are hereby authorized to take whatever action is deemed necessary in their judgment for the health of aforesaid child. By typing my name below, I also agree that I am solely responsible for the payment and all costs resulting from the rendering of medical and ambulance services.
32. By typing my name below, I give my child permission to be transported by the Town of Avon Recreation Department staff and personnel for the purpose of scheduled activities and trips.
34. By typing my name below, I give employees of the Town of Avon Recreation Department permission to apply sunscreen that is provided by me to my own child on an as needed basis, as prescribed by the directions on the bottle. If I do not supply sunscreen, I will allow the Town of Avon employees to use their sunscreen on my child.
36. By typing my name below, I give my child permission to watch G-rated and PG-rated movies while at camp.
38. By typing my name below, I give my permission to the Town of Avon to use photos or video segments of me or my family for promotional or publication purposes.
Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit Submit and Print

* indicates a required field