AT SWARTSWOOD STATE PARK

WEEKS OF AUGUST 16TH & AUGUST 23RD (9AM TO NOON)

AGES 6 THRU 12 (ENTERING INTO 1ST THRU 6TH GRADE)

REGISTRATION FEE IS $30.00 PER CHILD PER WEEK, PAYABLE AT TIME OF REGISTRATION. MAKE CHECKS PAYABLE TO:

STILLWATER TOWNSHIP, 964 Stillwater Rd. Newton, NJ 07860

THIS PROGRAM IS FOR STILLWATER TWP. RESIDENTS

PLEASE FILL OUT ONE APPLICATION PER CHILD.

NAME: ________________________WEEK #1_______WEEK #2_____

OR BOTH WEEKS ______ GRADE IN SEPT: ________________

CHILD’S SPECIAL NEEDS OR ALLERGIES:________________________

PARENT’S/GUARDIANS:______________________________________

ADDRESS:_________________________________________________

PHONE:___________________________________________________

EMERGENCY CONTACT & PHONE#______________________________

***This is NOT a school sponsored event***

SAVE HARMLESS CLAUSE: THE UNDERSIGNED HAS READ THE RULES AND REGULATIONS OF THE STILLWATER TWP. REC COMMISSION PERTAINING TO THE USE OF STILLWATER TWP/SWARTSWOOD LAKE FACILITIES AND AGREES TO ABIDE BY THEM. UNDERSIGNED FURTHER ASSUMES ALL RISK INCIDENT TO ITS OPERATION ON ITS SAID GROUNDS AND FACILITIES AND AGREES NOT TO SUE THE STILLWATER TWP. RECREATION COMMISSION/SWARTSWOOD LAKE OR THE TWP. OF STILLWATER. THE UNDERSIGNED FURTHER AGREES TO INDEMNIFY THE STILLWATER TWP. REC. COMM./SWARTSWOOD LAKE AND THE TWP. OF STILLWATER AND SAVE IT HARMLESS FROM ANY AND ALL CLAIM OR CLAIMS BROUGHT AGAINST IT BY OR ON BEHALF OF ANY PERSON, FIRM OR CORPORATION BASED UPON ANY ACT OR OMISSION OR ANY ALLEGED NEGLIGENCE OF THE UNDERSIGNED. THIS AGREEMENT IS MADE IN CONSIDERATION OF THE LICENSE OF A PERMIT TO THE UNDERSIGNED PERMITTING ITS REQUESTED OPERATIONS BY THE UNDERSIGNED ON LANDS AND PREMISES OF THE STILLWATER REC. COMM., SUBJECT TO ALL RULES AND REGULATIONS PERTAINING THERETO.

IN WITNESS, WHEREOF, I HAVE HEREUNTO SET MY HAND THE ____DAY OF ______2010.