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2021 Vernon Township Summer Day Camp Registration

  1. Is your child a returning camper?*
    (Did your child complete the 2019 camp and/or receive a full refund for the 2020 camp?)
  2. Gender*
  3. Resident of Vernon Township*
  4. Special Accommodation
    In accordance with the American with Disabilities Act, if your child needs any special accommodation to enable him or her to participate in an activity, please check this box.
  5. Payment
    A deposit of $95 is due by 4:00 p.m. on Friday, February 26th. Deposits must be made by check payable to: Vernon Township. A member of the camp staff will reach out to you upon receipt of your registration to arrange payment.
  6. Photography Notice
    Photos are periodically taken of participants in a camp, class, or special event. They are for Township use only and may be used in Township publications.
  7. Vernon Township Program Waiver & Release of All Claims
    Please read this form carefully and be aware that in registering yourself of your minor child/ward for participation in Vernon Township programs you will be waiving and releasing all claims for injuries you or your child/ward might sustain arising out of said programs. I recognize and acknowledge that there are certain risks of physical injury to participate in the above program and I agree to assume the full risk of any such injuries, damages or loss regardless of the severity which I or my child/ward may sustain as a result of participating in any activities connected to or associated with any such program. I waive and relinquish all claims I or my child/ward may have against the Township and its officers, agents, servants, and employees from any and all claims from injuries, damages, or loss which I or my child/ward may have or which may accrue to me or my child/ward on account of my participation or the participation of my child/ward in the above program. I further agree to indemnify and hold harmless and defend the Township and its officers, agents, servants, and employees from any and all claims resulting from injuries, damages, and losses sustained by me or by my child/ward and arising out, connected with, or in any way associated with the activities of any of the programs.
  8. Acknowledgement *
  9. Electronic Signature Agreement*
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
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  11. This field is not part of the form submission.