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2. ATTENTION

   PLEASE DO NOT REGISTER MORE THAN (1) ONE CHILD PER FORM.

4. Child's Name*
5. Last Grade Completed*
7. Parent/Guardian Name*
9. Address*
11. City*
12. State*
13. Zip Code*
15. Email Address*
16. West Hanover Township Residency*

    1. Resident

    1. Non-Resident
18. Home Phone Number
19. Work Phone Number
20. Cell Number
24. Emergency Contact*

    Must be different than above contact

25. Relationship to Child*
26. Contact Number*
28. Special Medical Concerns (if applicable)
32. Weeks Registering For*

    1. Week 1 - 6/12/23
    2. Week 2 - 6/19/23
    3. Week 3 - 6/26/23

    1. Week 4 - 7/3/23
    2. Week 5 - 7/10/23
    3. Week 6 - 7/17/23

    1. Week 7 - 7/24/23
    2. Week 8 - 7/31/23

    1. Week 9 - 8/7/23
    2. Week 10 - 8/14/23
34. PLEASE NOTE:

    There is a required minimum of 8-weeks

38. T-shirt Size*

    1. Y/S (6-8)
    2. Y/M (10-12)
    3. Y/L (14-16)

    1. A/S (34-36)
    2. A/M (38-40)
    3. A/L (42-44)
42. WAIVER OF LIABILITY AND ACKNOWLEDGEMENT*

    I hereby attest that the information provided in the summer recreation application is complete and accurate to the best of my knowledge.

    I hereby waive any claims for bodily injury, property damage, or other liability against the Township of West Hanover, and their respective agents, volunteers, and/or employees while our child(ren) is a participant in the Township Recreation Program.

    I consent to allow any pictures taken to be used in township publications for purposes of showcasing the program and advertising the program in the future.

    1. I agree.
44. Electronic Signature of Parent/Guardian*
45. Date*
Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit

* indicates a required field