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Recreation Worcester Registration - Summer 2017

The Recreation Worcester program is a FREE six (6) week summer recreation program located across ten (10) park locations in the City of Worcester, two in each city district.

Park Recreation (July 5th - August 18th)
Starting July 5th through August 18th, the City of Worcester will provide FREE recreational programming at ten (10) parks Monday through Friday from 9 a.m. - 5:30 p.m. Park locations are: Beaver Brook Park, Burncoat Playground, East Park, Grant Square Park, Greenwood Park, Indian Hill Park, Lake Park, Logan Field, University Park and Vernon Hill Park. Parks will be staffed by trained Youth Workers who will facilitate sports, literacy and arts programs, and includes lunch and dinner. Registration is required to participate in programming.

Please refer to schedules posted at the Recreation Worcester web page or calling Customer Service at 508-929-1300.

Please complete additional form submission(s) if you wish to register more than three children.

IMPORTANT: The Recreation Worcester - Additional Information Sheet must be completed in addition to your online registration. Please complete this form and bring it to your first programming session.

Participant Information

*Child's First Name
*Child's Last Name
*Date of Birth
MM/DD/YYYY
*Sex
    
Allergies/Special Health Considerations
Please list any and all allergies to food or medications.

Child's First Name
Child's Last Name
Date of Birth
MM/DD/YYYY
Sex
    
Allergies/Special Health Considerations
Please list any and all allergies to food or medications.

Child's First Name
Child's Last Name
Date of Birth
MM/DD/YYYY
Sex
    
Allergies/Special Health Considerations
Please list any and all allergies to food or medications.

Parent/Guardian Information

*Parent’s/Guardian's First Name
*Parent’s/Guardian's Last Name
*Cell Phone
Example: 5085551234
Cell Phone Carrier
Alternate Phone
Example: 5085551234
*Street Address (Include Apartment #)
*City
*State
*Zip Code
*Email Address

Parent’s/Guardian's First Name
Parent’s/Guardian's Last Name
Cell Phone
Example: 5085551234
Cell Phone Carrier
Alternate Phone
Example: 5085551234
Street Address (Include Apartment #)
City
State
Zip Code

Emergency Contact Information

*Primary Emergency Contact First Name
*Primary Emergency Contact Last Name
*Cell Phone
Example: 5085551234
Alternate Phone
Example: 5085551234
Street Address (Include Apartment #)
City
State
Zip Code

Secondary Emergency Contact First Name
Secondary Emergency Contact Last Name
Cell Phone
Example: 5085551234
Alternate Phone
Street Address (Include Apartment #)
City
State
Zip Code

Your child(ren) can be released from the program to the following individuals
(Please list if different from the above emergency contacts):

Release Consent

First Name
Last Name
Relationship to Child(ren)

First Name
Last Name
Relationship to Child(ren)

Registration Information

*Park Registration (If you are signing up with summer school, please see attached site your school will be attending.)
Please select which park for which you would like to register
if you are not attending summer school.
*Do you give permission for your child(ren) to walk home from the Recreation Worcester site?
    
*Do you give permission for your child(ren) to be photographed for any reason for the duration of the Recreation Worcester Program?
    
*Does your child qualify for free or reduced lunch?
    
Ethnicity
*For grant funding purposes only.

By checking the following box, I, parent/legal guardian of registered participant(s), hereby understand that:
  1. I am registering my child as a participant in the Recreation Worcester Program.
  2. My child is between the ages of 7 and 13.
  3. My child must remain at the recreation site at all times unless other agreements have been made.
  4. My child must be picked up no later than 5:30 p.m. unless he/she is granted permission to walk home from the site. Continued violations of this rule will result in my child's termination from the program.
  5. My child may be removed from the Recreation Worcester Program for misbehavior.
  6. All required information being provided in this registration form is both accurate and true.
  7. I must provide and keep current all emergency contact information regarding my child.
  8. Recreation Worcester and its affiliated partner agencies are not responsible for lost, stolen or damaged items.
  9. I understand that it is not recommended that the participant bring any electronic devices such as cell phones, iPods, mp3 players, headphones, etc.
  10. The program recommends participants to bring a backpack, water bottle and sunscreen daily.

*Please Check
  
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