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Summer Recreation Registration

Published May 22, 2024

Summer Playground Registration


Child’s name: __________________                      Birth Date:________

Address:_______________________                     Age:_____________

Phone:_________ Cell Phone:__________            Gender: M / F

E-mail address:__________________

Parent’s Name_______________________           Work Phone:__________

Address: ___________________________

Insurance Info:_____________________               Policy # ____________


Emergency Contact__________________              Phone:______________





Any other medical concerns:___________________________________


    I hereby give the Village of Phelps Recreation staff permission to seek         medical attention for my child if it is a life threatening situation or if they are unable to reach any of the people above.

          Signature:_________________________ Date:____________


I hereby give permission to have __________________ photographed and used in the local newspaper or summer playground album.  I release the Village of Phelps from liability.

       Signature__________________________ Date:_____________


I also understand that if my child decides to leave during the hours of operation that  he/she are not allowed back into the program until the next day and the Village of Phelps is not responsible for the behaviors or actions of my child.            Signature:__________________



2024 Summer Recreation dates 7/8/24 – 8/16/24

Appropriate for Ages 5-13, Grades K-8; Mon.-Fri. 1:00-4:00