Summer at Newton Program

Registration

Please choose what programs your child(ren) will be participating in:

Summer at Newton Youth Program (Monday-Thursday, 11:30am-2pm)

Summer Lunch Program (Monday-Thursday, 12pm-1pm)

Participant Name #1:(Required)

First Last

Date of birth:(Required)

School:(Required)

Grade:(Required)

Any allergies or health concerns?(N/A if there are no concerns)(Required)

Participant Name #2 (If applicable):

First Last

Date of birth:(Required)

School:(Required)

Grade:(Required)

Parent/Guardian Name:(Required)

Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number:(Required)

Email:(Required)

Any allergies or health concerns? (N/A if there are no concerns)(Required)

Emergency Contact:(Required)

First Last

Relationship (Mother, Father, Sister, etc.):(Required)

Phone Number:(Required)

Terms & Conditions:(Required)

I agree

NCC Youth programs are drop-in, not licensed child care, and therefore the expectation is that the participants are mature enough to handle a less-structured environment. While we provide a safe and supervised atmosphere, staff work in various rooms and therefore do not provide line-of-sight supervision at all times. Youth who are not registered, including guests of registered participants, will not be permitted to attend the NCC Drop-In program or enrichment clubs.
I understand that my child(ren) shall abide by all the rules, regulations, agreements, criteria and guidelines of the City of Salisbury and the Newton Community Center and that his/her failure to do so will give the City of Salisbury the right to immediately suspend or terminate his/her participation. I understand that I may have to pick my child(ren) up if he/she does not abide by these rules.
I also give permission for my child(ren) to be photographed and videotaped by the City of Salisbury and authorized members of the media for promotional material or for any other purposes, including publicity. I release the City of Salisbury from any and all claims and liability in regard to said photographs and footage.
I understand and voluntarily assume on my own behalf and on behalf of my child(ren) all risks inherent in participation in the programs; and I waive all claims,
actions, costs, liabilities, expenses and judgments against City of Salisbury and Newton Community Center and release City of Salisbury and its directors, officers, agents, representatives, and employees from claims, action, costs, liabilities, expenses and judgments arising out of my
child’s participation in the programs. I further agree to indemnify City of Salisbury and it’s directors, officers, agents, representatives, and employees and hold them harmless
for any and all claims, damages, actions, liabilities, and expenses, including attorney’s fees, arising out of my child’s participation in the programs.
City of Salisbury has my permission to take whatever steps it deems necessary to properly care for and supervise my son/daughter, including the rendering
of emergency medical care in the event that any situation occurs whereby an agent or employee of Newton Community in the exercise of his/her discretion, assesses that immediate action is necessary and/or in the event my child is injured and I cannot be reached within a
reasonable time under the circumstances.
My signature below indicates my understanding and agreement with all terms set forth in this registration. I agree that I will cooperate fully with all City of Salisbury personnel and will notify Newton Community center in writing if any information set forth on this registration form
changes in any way