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The Teen Travel Camp is a seven week travel program designed exclusively for “teens” entering 7th, 8th, 9th, & 10th grades in the
fall of 2010. Registration fee includes: transportation for trips, admissions to activities, and a T-shirt for each registrant. Each
day the group will meet at the Ewing Senior/Community Center at 999 Lower Ferry Road. Camp hours will be from 8:30 a.m.
to 4:30 p.m. with extended hours for longer trips. *Changes in trips may be required due to the weather, availability, etc. *For
more information on schedules or if you have questions, call the Recreation Office or Diane Fisher, director, at 609-915-6186.
*Campers entering 10th grade have the option of enrolling in the Teen Travel program and/or the CIT
program through the Ewing Recreation Day Camp. They have the choice of splitting the weeks up between
the two programs if preferred. Separate registration form for the Day Camp is required to be completed if
splitting the weeks.
PARENT or GUARDIAN INFORMATION (Please include home address if different than camper.)
If parents live at different addresses, do you want camp information to be sent to both? ____Yes ____No
EMERGENCY INFORMATION
In the event the parent(s) or guardian can not be reached please contact:
Will teen need to take medication during the camp day? _____ (If yes, attached medication form MUST be
completed)
PICK UP AUTHORIZATION
The following person(s) are authorized, in addition to the mother and father or guardians listed above,
to pick up my teen from the Ewing Recreation Teen Travel Camp.
__________________________________________________________________________________________
Name Phone # Relationship to Teen
__________________________________________________________________________________________
Name Phone # Relationship to Teen
__________________________________________________________________________________________
Name Phone # Relationship to Teen
TEEN TRAVEL CAMP WEEKS & COSTS – Week 1: $200 for residents; $300 non-residents.
All other weeks (except week 6) $250 per week for residents; $375 per week for non-residents.
Week 6-overnight trip: $275 for residents; $400 for non- residents.
(Please check the specific weeks attending and residence status) ____ Resident ____ Non-Resident
________________________________________________________________________________________
________________________________________________________________________________________
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Make Checks payable to “EWING RECREATION DEPARTMENT”
($50 per week deposit must accompany registration form)
Amount paid: ___________ Partial pmt. _____ or Full Pmt. _______ Received by: __________________
ACKNOWLEDGEMENT OF RISK
I am aware that participating in this activity can be dangerous and involves risk of injury. I realize that
participation in the above-mentioned activity presents risk, which includes minor or serious injury to any part of
the body. These injuries could lead to temporary or permanent disability or even death.
While the possibility of serious injury to participants is unlikely, it is important that all participants and
parents realize that these risks do exist.
PARENT/GUARDIAN AGREEMENT
I also recognize and acknowledge that there are certain risks of physical injury inherent in the named
minor’s participation in this program. I have received, read, and understand the risks and have discussed them
with my teen. He/she understands that he/she must obey all rules and regulations, follow all safety procedures,
and obey any and all instructors, assistant instructors, and staff members assigned to the program. My teen and
I understand the risk associated with this program, my teen and I agree to accept our responsibility in making
this program a safe one.
I certify that the minor is in proper physical condition for safe participation in the Ewing Recreation
Teen Travel Summer Camp, and I agree that it is incumbent upon me to immediately inform the Ewing
Recreation Teen Travel Director should the minor’s physical condition change at any time prior to or during
his/her participation in the program.
I expressly agree that this agreement is intended to be as broad and inclusive as permitted by the Laws
of the State of New Jersey and that if any portion of the agreement is held invalid, it is agreed that the balance
shall continue in full legal force and effect and be valid.
In consideration of the Ewing Recreation Department permitting the name minor to participate in the
Recreation Department previously mentioned, the undersigned, being the parent(s) or legal
The Teen Travel Camp reserves the right to evaluate any child with physical, mental, or emotional disabilities prior to camp. For the general
welfare of campers, the Camp reserves the right to dismiss any camper whose conduct or influence is inimical to the Camp’s best interest. I
hereby give permission to the Ewing Recreation Teen Travel Camp to take my teen on trips outside of the camp. The Director and staff will
exercise every reasonable precaution consistent with safety, health, and care. Furthermore, in the event that I or my family physician can not
be contacted in the event of an emergency, I hereby grant permission to the nearest medical facility to provide a physician and to give
emergency treatment to my child.
_______________________ ___________________________________________
Date PRINT NAME