important summer camp registration …herefordrec.org/files/herefordrec/summer camps/smr...

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IMPORTANT SUMMER CAMP REGISTRATION INFORMATION Baltimore County Department of Recreation and Parks in conjunction with the Hereford Zone Recreation and Parks Council and Prettyboy Recreation Council is pleased to offer this variety of summer camp experiences for youth in the Hereford Community. We hope you find this newsletter to be a useful resource and our camps to be both enjoyable and rewarding. Please read the following information carefully, so that your camp registration is received and processed correctly and promptly. You must complete a separate registration form for each child and each program. For example: If you are registering two different children, each participating in two different camps, you will need to fill out four forms and write 2 checks. Registration form is on page 8 of this newsletter. Please pay attention to the registration instructions for each camp. Some camps require online registration while others require mail-in registration. If you are registering your child for a camp with mail-in registration, you must write a separate check for each camp for which you wish to register. For example, if you are registering one child for two different camps, you will need two checks. However, if you are registering two children in the same camp, only one check will be needed. The mail-in registration form is available on page 8 of this newsletter. Online registration requires a credit card for payment. IMPORTANT: ALL CHECKS SHOULD BE MADE PAYABLE TO: HEREFORD ZONE RECREATION AND PARKS COUNCIL or HZRPC. Place check and completed registration form in an envelope and mail to: Hereford Recreation Office—Summer Camp 17301 York Road Parkton, MD 21120 Should you require special accommodations (i.e., sign language interpreter, large print, etc.), please give as much notice as possible by calling the Therapeutic Office 410-887-5370 (voice) or 410-887-5319 (TTY/Deaf) These programs are neither sponsored by nor endorsed by BCPS Hereford Recreation Office 17301 York Road Parkton, MD 21120 410.887.1938 Page 1 MAKE A DIFFERENCE; GET INVOLVED - The Department of Recreation and Parks was established in 1949 to help the citizens of Baltimore County meet their leisure needs. To this end, community Recreation and Parks Councils were created to partner with the Department. These non-profit councils are composed entirely of volunteers who donate their time and efforts to provide their families, their neighbors or perhaps themselves with a wide variety of recreational opportunities - locally and affordably. Your local recreation councils are always in need of volunteers to help in a variety of roles. Make a difference; Get Involved! Visit your Recreation Council’s website or contact the Hereford Recreation Office to find out how: Prettyboy Recreation Council: prettyboyrecreationcouncil.com Seventh District Recreation Council: seventhdistrictrec.com Hereford Zone Recreation and Parks Council: herefordrec.org

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Page 1: IMPORTANT SUMMER CAMP REGISTRATION …herefordrec.org/files/HerefordRec/Summer Camps/SMR CAMP...WHERE: Prettyboy Elementary School WHO: Ages 2-12 COST: $184/week $10 off for multiple

IMPORTANT SUMMER CAMP REGISTRATION INFORMATION Baltimore County Department of Recreation and Parks in conjunction with the Hereford Zone Recreation and Parks

Council and Prettyboy Recreation Council is pleased to offer this variety of summer camp experiences for youth in the

Hereford Community. We hope you find this newsletter to be a useful resource and our camps to be both enjoyable and

rewarding. Please read the following information carefully, so that your camp registration is received and processed

correctly and promptly. You must complete a separate registration form for each child and each program. For example: If

you are registering two different children, each participating in two different camps, you will need to fill out four forms and

write 2 checks. Registration form is on page 8 of this newsletter.

⇒ Please pay attention to the registration instructions for each camp. Some camps require online registration while

others require mail-in registration.

⇒ If you are registering your child for a camp with mail-in registration, you must write a separate check for each camp for

which you wish to register. For example, if you are registering one child for two different camps, you will need two

checks. However, if you are registering two children in the same camp, only one check will be needed. The mail-in

registration form is available on page 8 of this newsletter.

⇒ Online registration requires a credit card for payment.

⇒ IMPORTANT: ALL CHECKS SHOULD BE MADE PAYABLE TO:

HEREFORD ZONE RECREATION AND PARKS COUNCIL or HZRPC.

Place check and completed registration form in an envelope and mail to:

Hereford Recreation Office—Summer Camp

17301 York Road

Parkton, MD 21120

Should you require special accommodations (i.e., sign language interpreter, large print, etc.), please give as much notice as

possible by calling the Therapeutic Office 410-887-5370 (voice) or 410-887-5319 (TTY/Deaf)

These programs are neither sponsored by nor endorsed by BCPS

Hereford Recreation Office 17301 York Road Parkton, MD 21120 410.887.1938

Page 1

MAKE A DIFFERENCE; GET INVOLVED - The Department of Recreation and Parks was established in 1949 to help

the citizens of Baltimore County meet their leisure needs. To this end, community Recreation and Parks Councils

were created to partner with the Department. These non-profit councils are composed entirely of volunteers who

donate their time and efforts to provide their families, their neighbors or perhaps themselves with a wide variety of

recreational opportunities - locally and affordably. Your local recreation councils are always in need of volunteers

to help in a variety of roles. Make a difference; Get Involved! Visit your Recreation Council’s website or contact the

Hereford Recreation Office to find out how:

Prettyboy Recreation Council: prettyboyrecreationcouncil.com

Seventh District Recreation Council: seventhdistrictrec.com

Hereford Zone Recreation and Parks Council: herefordrec.org

Page 2: IMPORTANT SUMMER CAMP REGISTRATION …herefordrec.org/files/HerefordRec/Summer Camps/SMR CAMP...WHERE: Prettyboy Elementary School WHO: Ages 2-12 COST: $184/week $10 off for multiple

Page 2

HEREFORD BULLS TENNIS CAMP

WHERE: Hereford Middle School WHEN: 9 am—12 pm WHO: Ages 9-15 COST: $175 per session. Each session is limited to 12 campers.

Whether you’re a beginner, an intermediate or an advanced player, this pro-gram will improve your game and help you get more enjoyment from tennis. Focus will be on skill refinement as well as practice and match play to develop consistent, well-rounded tennis players. Hereford Bulls tennis breaks down

the fundamental skills of tennis through easily understood games and exercises to help improve the athlete’s overall coordination and technique. Players learn proper grips, footwork, strokes, volleys and serves during a series of drills and games designed to teach skills in a fun and dynamic way. Athletes will learn the rules and etiquette that make tennis such an exciting game to play. Instructor is Elizabeth Zinkand, PE teacher at Hereford Middle School, assistant Tennis Pro and Camp Director at the Roland Run Club for 8 years. Questions? Contact Elizabeth Zinkand at 410-493-1244 or [email protected] To Register: Mail-in registration. See page 1.

SPARKS PHYSICAL EDUCATION CAMP

WHERE: Sparks Elementary School COST: $125 half day or $205 full day (weekly) This camp offers a variety of sports, team-building, arts and crafts, games and water activities. Instructed by Sparks Elementary PE teacher Melinda Hoffman. Questions? Contact Melinda Hoffman at [email protected] or 410-887-7900. To Register: Mail-in registration. See page 1.

BULLS FIELD HOCKEY CAMP

Hereford High School Stadium

Field Hockey players will enhance their foundation of basic skills as well as increase their knowledge of the game with a focus on team play. Middle School athletes will be exposed to conditioning relevant to the game of

hockey. Goal keepers are welcome to attend. Instructor is Caitlin Duvall, current Hereford HS head varsity field hockey coach who led the Bulls to three consecutive State Championships in 2014, 2015 and 2016. Assistant instructors are former members of the HHS field hockey teams. Questions? Contact Caitlin (MacKenzie) Duvall at [email protected] or 734-904-3411 To Register: Mail-in registration. See page 1.

HEREFORD GIRLS VOLLEYBALL CAMP

WHERE: Hereford High School Gymnasium WHEN: July 16-19 8 am-12 pm WHO: Ages 7-15 COST: $100

Campers will be introduced to the fundamentals of volleyball, footwork, receiving, passing, hitting, serving and court play. All campers will have the opportunity to improve their volleyball skills and knowledge of the game.

This is a great opportunity for incoming 9th graders that plan to tryout for volleyball at the high school level. The camp will be conducted by David Schreiner, the Hereford HS volleyball varsity coach.

Questions? Contact: Elizabeth Carey at 443-610-7757 or [email protected] To Register: Mail-in registration. See page 1

Session 1 Session 2 Session 3

June 18-22 June 25-29 July 9-13

Session 4

July 16-20

Session 5

July 23-27

Session 1 June 18-22 Grades 5 & 6 in fall 2018

Session 2 June 25-29 Grades 3 & 4 in fall 2018

Session 3 July 2-6 excluding 7/4

Grades 1 & 2 in fall 2018

9-12 pm or 9-2 pm

9-12 pm or 9-2 pm

9-12:45 pm

Session 1 June 19-22 Grades 3—5 in fall 2018 9 am -12 pm

Session 2 June 19-22 Grades 6—9 in fall 2018 9 am -1 pm

$97 per session

$127 per session

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PRETTYBOY HOMEBASE SUMMER PROGRAM

WHERE: Prettyboy Elementary School WHO: Ages 2-12 COST: $184/week $10 off for multiple children in same family

This program is open all summer for your daycare needs beginning on Monday of the first full week after school closes for the summer. Hours of operation are 6:30am to 6:00pm Monday—Friday. Closed July 4th.

The program runs until the last week before the 2018/19 school year begins. Activities include themed weeks, entertainment, crafts, indoor and outdoor games and so much more to even mention.

Plan a week with us or the whole summer. Daily and half-day rates available upon request. Contact for more information or to register:

Judy Ober at 410-357-9509 or [email protected]

FUN & FITNESS CAMP

WHERE: 5th District Elementary School WHEN: 9 am—12 pm COST: $100 / session

Campers will play a variety of physically active games and activities as well as crafts and learning experiences that will cover a variety of health and fitness components. Camp instructor is 5th District Elementary School PE teacher Steve Bruso. Questions? Contact Steve Bruso at sbruso.bcps.org To Register: Mail-in registration. See page 1.

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BULLS BASKETBALL CAMP

WHERE: Hereford High School Gymnasium WHEN: 9 am-2 pm WHO: Boys ages 7-14 COST: $150 per session

Boys basketball camp will focus on teaching and working on skills and fundamentals of the game. There are full-court games, a 3 on 3 tournament, daily contests and prizes. The camp is conducted by Hereford High coaches Jim Rhoads and Mike Kalisz. Questions? Contact Mike Kalisz at 410-887-1910 or [email protected]

To Register: Mail-in registration. See page 1.

GIRLS BASKETBALL CAMP

WHERE: Hereford High School Gymnasium WHEN: July 9-13 9 am-2 pm WHO: Girls ages 9-14 COST: $150 per camper Girls basketball camp will focus on teaching and working on skills and fundamentals of the game. There are full-court games,

a 3 on 3 tournament, daily contests and prizes. The camp is conducted by Hereford High coach Jim Rhoads. Questions? Contact Jim Rhoads at [email protected] or 410-917-5563

To Register: Mail-in registration. See page 1.

HEREFORD GIRLS SOCCER CAMP

WHERE: Hereford High School Stadium WHEN: 8 am-12 pm COST: $157 per session

This camp will be divided by age group. The younger age group is designed with the elementary school child in mind. It will focus on making the game fun and enjoyable for athletes of that age. There will be focus on developmental skills, games and having fun playing the sport. The older age group will be designed to give middle school-aged girl soccer players an idea of what to expect from the high

school program. It will help prepare them for the high school team, incorporating skills, endurance and strength into a comprehensive camp. Instructor is Brad Duvall, head varsity girls’ soccer coach at Hereford HS with twelve years coaching experience. Assisting Brad are two Hereford HS graduates both having played soccer at the college level. Questions? Contact Brad Duvall at [email protected] or 410-984-5191 To Register: Mail-in registration. See page 1.

Session 1 June 25-29 Grades K-5 in fall 2018

Session 2 July 9-13 Grades K-2 in fall 2018

Session 3 July 23-27 Grades 3-5 in fall 2018

Session 4 July 30-Aug 3 Grades 3-5 in fall 2018

Session 1 Session 2

June 18-22 June 25-29

Session 1 June 25-28

Session 2 July 30-Aug 2

Ages 6-12

Ages 13-14

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UK ELITE SOCCER

WHERE: Prettyboy Elementary School This is a week long camp to introduce young players to soccer. Focus is on learning technical and small-sided tactics, while teaching players to love the game. Questions? Contact Robert Hough at 410-274-8662 or [email protected] To Register: ONLINE-Visit prettyboyrecreationcouncil.com and click on ‘Outdoor Soccer” Follow links to Stone Alley online registration page.

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HEREFORD BOYS LACROSSE

WHERE: Hereford High School Stadium Field WHEN: June 11, 12 & 13 (Rain date 6/14) COST: $95

Camp led by Hereford HS boys’ varsity coach Sal Picataggi. Learn from some of the top coaches and players in the state. Campers will be grouped according to age and ability for maximum learning. Every position covered. This is a great opportunity for players to improve their skills and lacrosse IQ. All players need

to have their own equipment. Camp reversible provided plus daily giveaways. Questions? Contact Sue Bowen at 410-357-9323 or [email protected]

To Register: ONLINE-Visit herefordlacrosse.org and click on “Boys Lacrosse Camp” link.

HEREFORD RUNNING CAMP

WHERE: Hereford High School Cross Country Track WHEN: July 30-August 4 8—10:30 am WHO: Those entering grades 6-12 in fall 2018 COST: $150 per session

This camp is designed to provide training on the disciplines of Cross Country and Distance Track running. It is for partici-pants of all ability levels and the instruction is geared to help all campers improve their skills. The camp will include summer planning, conditioning and racing training from experienced college athletes. The campers will improve their overall fitness and endurance level whether they compete in Cross Country or Track or utilize this instruction for other sports and activities. Instructors are Zachary Lang and Matthew Kingeter. Both have competed in Cross Country and Track for 12 seasons while at Hereford HS, served as team captain during their senior year and were awarded Athlete of the Year by the Hereford Harbinger as seniors. They currently run Cross Country and Track at St. Lawrence University and UMBC respectively. Questions? Contact: Zachary Lang at [email protected] To Register: Mail-in registration. See page 1.

HEREFORD WRESTLING CAMP

WHERE: Hereford High School Wrestling Room .

Questions? Contact: Robert Hough at [email protected] To Register for sessions 1 and 2: ONLINE-Go to herefordrec.org and click on “Wrestling Camp” link.

Session 1 July 2, 3 & 5

Session 2 July 17-19

For boys all ages

For girls ages 5-8

Session 3 July 23-27 For boys and girls

ages 8-14 (no high schoolers)

$200

$50

$75

FITS—Steve Fittery, a 4-time college all-American will provide expert instruction for wrestlers of all ages and experience. For ques-

tions about this camp, email [email protected]

Wrestling instruction by Coach Robert Hough with addition of several local area female wrestlers.

Wrestling instruction by Coach Robert Hough with addition of several local wrestlers.

8 am—6 pm

6-8 pm

6-8 pm

Session 1 June 11,12 & 13

Session 2 June 11,12 & 13

5-6:30 pm

6-8 pm

For ages 5-11

For ages 12-15

Session 1 Session 2

July 23-27 July 23-27

9-12 pm 9-3 pm

For ages 5-13 For ages 7-14

$170 $240

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PRETTYBOY ART

WHERE: Prettyboy Elementary School WHEN: 8 am—12 pm COST: $100 WHO: Grades 1—6 in fall 2018

During each camp week, students will create 5-7 different and unique art projects under the instruction of Prettyboy Elementary School’s art teacher, Mr. Jim Briggs. This camp is offered to all students entering 1st—6th grade this fall. Art projects will vary for both young (1st & 2nd graders) and old (3rd-5th graders), and all students will work in the following art forms: drawing, painting, clay, collage, and mixed-media. Master Artists will be observed through-out the week. Students will create a plan for most of their artworks in a supplied sketchbook. In addition to a sketchbook, all other art materials will be supplied; however, students may bring their own if they’d like. We do take a couple of breaks in between art projects, and students will need to bring one or two light snacks and drinks each day of the week.

Questions? Contact Heather Lang at 443-739-0588 or [email protected] To Register: ONLINE-Visit prettyboyrecreationcouncil.com and look for Summer Art Program information.

Session 1 June 18-22

Session 2 July 30—Aug 3

MUSIC AND ART

WHERE: 5th District Elementary School WHEN: 12:30 –3:30 pm COST: $125 / session All sessions have a free optional 12 pm arrival time for campers to bring and eat their lunch.

Session 1: Musical Movement—This week is perfect for students who want to experience fun games, activities and projects from music and art during the school year in a single week! Campers will be exposed to the cultural heritage of various group dances, including circle, line, square and folk dances. Crafts will reinforce the cultures that are introduced throughout the week. Session 2: Primary Zumba—This high-energy camp will be the highlight of your child’s summer. Featuring age appropriate Latin tunes, campers will express them-selves via dance and aerobic movements. This basic Zumba class will include elements of hip-hop, samba, salsa, merengue and mambo. The camp will also feature traditional camp crafts completed during intermittent “cool-down” periods. This camp is ideal for youngsters seeking to improve muscular strength and cardiovascular endurance. Session 3: Intermediate Zumba—In this advanced version of the Zumba camp, children will improve mobility, stability, flexibility and cardiovascu-lar function by incorporating elements of hip-hop, samba, salsa, merengue and mambo. Zumba is a full-body workout which will improve campers’ muscular endurance by focusing on low impact, high reps along with aerobic movements made to an array of Latin beats. The camp will also include traditional camp crafts completed during periodic “cool-down” periods. Session 4: Recorder Express—A fun way for children to improve their overall skill and proficiency as musicians; this is the perfect camp for those children interested in furthering their exposure to the recorder as a foundational musical instrument. Campers will utilize the Recorder Express pro-gram to learn how to read music and play the recorder. This camp will provide basic knowledge for those students who will be learning recorder in the fall, or want to expand pre-existing recorder skills. Guided instructional time will be broken up by creative craft activities and musical games. All sessions co-led by Katie Hosier, Vocal/General Music Teacher at 5thDES and Fiona Coulter, Art Teacher at 5thDES. Questions? Contact: Katie Hosier at [email protected] To Register: Mail-in registration. See page 1.

Session 1 June 25-29 Grades K-5 in fall 2018

Session 2 July 9-13 Grades K-2 in fall 2018

Session 3 July 23-27 Grades 3-5 in fall 2018

Session 4 July 30-Aug 3 Grades 3-5 in fall 2018

WeDo LEGOS and WeDo LEGOS, JR.

WHERE: Sparks Elementary School WHEN: 9 am—12 pm COST: $160 Building with Legos is fun! Programming Legos is even better! In this program, stu-dents will build and then program their creations using the computer, special motors and sensors. Little hands will make big creations and practice their critical thinking and problem solving skills. Questions? Contact Justin Hennaut at [email protected] To Register: ONLINE-Go to herefordrec.org. Under “Summer Camps”, you will find a link to this camp.

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Session 1 Session 2

June 25-29 July 23-27

For grades 3-6 in fall 2018 For grades K-2 in fall 2018

(Jr. session)

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DISCOVERING SCIENCE and DISCOVERING SCIENCE, JR.

WHERE: Sparks Elementary School WHEN: 12:30-3:30 pm COST: $170 per session All students need opportunities to observe, explore and investigate the world around them. Skills learned in the study of science are an absolute necessity in the 21st century. Join us as we observe, explore and investigate some of sciences’ most puzzling and fun phenomenon. From how to cook s’mores using the sun to the best fuel for a rocket, campers will act as scientists as they walk through the scientific pro-cess and conduct investigations. So grab your lab coat and join us to uncover the secrets of science in Discovering Science! Questions? Contact Justin Hennaut at [email protected] To Register: ONLINE-Go to herefordrec.org. Under “Summer Camps”, you will find a link to this camp.

Session 1 June 25-29 For grades 3-6 fall 2018

Session 2 July 23-27 For grades K-2 fall 2018

(Jr. session)

KIDS THAT CODE: ROBOTS and KIDS THAT CODE: ROBOTS, JR.

WHERE: Sparks Elementary School WHEN: 9 am —12 pm COST: $160 per session

Programming goes beyond the computer in this camp. Our Kids that Code: Robots program helps students develop skills like strategic thinking and logic while engaged in problem based learning. Using various robotic elements like Ozobots and Spheros, students will learn to program these robots to follow their commands to complete a task and navigate through homemade obstacle courses.

Questions? Contact Justin Hennaut at [email protected] To Register: ONLINE-Go to herefordrec.org. Under “Summer Camps”, you will find a link to this camp.

Session 1 July 9-13 For grades 3-6 fall 2018

Session 2 August 13-17 For grades K-2 fall 2018

(Jr. session)

DESIGN.BUILD.ENGINEER and DESIGN.BUILD.ENGINEER, JR.

WHERE: Sparks Elementary School WHEN: 12:30—3:30 pm COST: $170 per session Many skills can be learned and strengthened when students are given the opportunity to design, build and create. Think about it, what could you make with just your imagination and some common materials? Could you make something that launches a marshmallow or make a kite that flies? This camp is all about creation, invention and tinkering! With only the materials provided and their creativity, thinking ‘outside the box’ will be the key to this camp. So put on your thinking cap. If you can imagine it, you can make it here! Questions? Contact Justin Hennaut at [email protected] To Register: ONLINE-Go to herefordrec.org. Under “Summer Camps”, you will find a link to this camp.

Session 1 July 9-13 For grades 3-6 fall 2018

Session 2 August 13-17 For grades K-2 fall 2018

(Jr. session)

KIDS THAT CODE and KIDS THAT CODE, JR.

WHERE: Seventh District Elementary School WHEN: 9 am—12 pm COST: $160 per session Computer programming is basic literacy in this digital age. Students must be able to not only consume technology, but also understand and control it. In this program, students will develop their problem-solving skills through hands-on exploration of coding basics. Students will explore Lightbot, code.org and MIT’s Scratch to program basic animations and games.

Questions? Contact Justin Hennaut at [email protected] To Register: ONLINE-Go to herefordrec.org. Under “Summer Camps”, you will find a link to this camp.

Session 1 July 23-27 For grades 3-6 fall 2018

Session 2 August 6-10 For grades K-2 fall 2018

(Jr. session)

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Page 7

ANIMATION STUDIO and ANIMATION STUDIO, JR.

WHERE: Seventh District Elementary School WHEN: 12:30—3:30 pm COST: $160 per session

Love Disney/Pixar movies? Have an interest in animated characters on tv? Then join the animation studio. In our studio, students will learn the art of animation. Students will explore different methods of animation and experiment with each before working in cooperative groups to create a final project. Animation methods include flip books, clay-mation, stop-motion and simple computer animation. Imaginations will be put to the test in this fun and creative camp. Questions? Contact Justin Hennaut at [email protected] To Register: ONLINE-Go to herefordrec.org. Under “Summer Camps”, you will find a link to this camp.

Session 1 July 23-27 For grades 3-6 fall 2018

Session 2 August 6-10 For grades K-2 fall 2018

(Jr. session)

IN THE SPOTLIGHT!

WHERE: Sparks Elementary School WHEN: July 30—August 3, 9 am—12 pm WHO: Grades 3—6 in fall 2018 COST: $160 per session

Your student is the star of their own film in this camp! In the Spotlight takes students through the filmmaking process from start to finish. Students will learn the basics of filmmaking and will work in collaborative groups to produce their own film or music video. Students will start with an idea, create a story map, write a script, design props, scout locations, shoot their scenes, and edit their film. The camp ends with a premiere party at the end of the week. Questions? Contact Justin Hennaut at [email protected] To Register: ONLINE-Go to herefordrec.org. Under “Summer Camps”, you will find a link to this camp.

PLAY IT AGAIN GAMES

WHERE: Sparks Elementary School WHEN: July 30 - August 3, 12:30 - 3:30 pm WHO: Grades 3-6 in fall 2018 COST: $160

Game night is alive and well in this program! While many kids today enjoy electronic gaming systems, many have missed out on the joys of simple board games, puzzle games and cooperative play games. In this camp, participants will play them all, from low-tech board games to high-tech puzzle games; maybe even an Escape Room or two. The camp will culminate with students creating their own game, which they will showcase during our Family Game Day on Friday. Game on! Questions? Contact Justin Hennaut at [email protected] To Register: ONLINE-Go to herefordrec.org. Under “Summer Camps”, you will find a link to this camp.

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2018 SUMMER CAMP REGISTRATION FORM

BALTO. COUNTY DEPT. OF REC. AND PARKS / HEREFORD ZONE RECREATION AND PARKS COUNCIL

CAMP NAME: ____________________________________ SESSION #:________ DATES:_____________________

The participant should complete this registration form, or if the participant is a minor/child, the legal authorized parent or guardian of minor/child participant must complete and sign.

Enrollment Information: Participant’s Name: ____________________________________________ Date of Birth: ____/____/____ Male: ____ Female: ____

Street Address: _____________________________________________Home Phone: ____________________________________

City/State: ________________________________ Zip Code: _________ Parent’s E-Mail: ____________________________________

School Attending____________________________________________

Emergency/Health Issues: In case of emergency, please notify (if minor/child participant, provide parent’s information or Guardian, as appropriate).

Name:_________________________________ Relationship:______________ Home Phone_________________ Cell Phone______________________

Name:_________________________________ Relationship:______________ Home Phone_________________ Cell Phone______________________

Physician’s Name: ____________________________________ Physician’s Phone: ____________________________________________

Name of Medical Provider: _______________________________________ Date of last tetanus immunization: ______________________

Any medical, psychological, or behavioral conditions we should be aware of (bee stings, food allergies, etc.)?________________________

1. Are there any medical, health factors or limitations that might affect participant’s performance in the activity? Yes ___ No ___

2. Is participant taking any medications or have a condition that may affect participant’s safety or performance in the activity? Yes ___ No ___

3. Is participant required any special accommodations (due to disability) to participate in the activity? Yes ___ No ___

If yes, please explain: ________________________________________________________________________________________________________

In case of injury or emergency, I for myself and/or participant (if participant is minor/child), and my personal representatives, heirs and assigns, (severally and collectively “I” for this registration form) give permission for an activity representative to call 911 and transport participant to a hospital. I shall inform the Recrea-tion Council, in writing, of any medical or health conditions of participant that occurs or develops and which could affect participant’s safety, performance or par-ticipation in or throughout the activity.

Signature of participant or, if minor, of parent/guardian: _______________________________________________________ Date: ________________

ACKNOWLEDGEMENT, WAIVER AND RELEASE OF LIABILITY:

I hereby confirm participant is in good health and able to participate in the activity. I acknowledge the activity may involve risk and danger of bodily injury or death. I fully accept and acknowledge the activities may in involve risk, and I hereby assume the risk and responsibility for all dangers and risks associated with the participant in the activity. . I further understand that concussion information is available at www.cdc.gov/concussion

I acknowledge Baltimore County, Maryland, the recreation council, and their respective employees, directors, officers, volunteers, members and any other partici-pant, entity, party or person involved in any regard with the activity or the activity premises and their respective agents, personal representatives, heirs, employ-ees, contractors, successors and assigns (each on “activity representative” and collectively the “activity representatives”), shall not be responsible or liable in any regard or manner for any and all property damage or bodily injury (including serious physical injury or even death) incurred by participant or any party related thereto as a result of his/her participation in the activity.

I have read, fully understand, and hereby freely sign, approve of, and agree to the terms of this registration form. I hereby unconditionally release, discharge, covenant not to sue, waive my rights and remedies, and agree to hold harmless the activity representatives from any and all claims, costs, demands, losses, dam-ages, or expenses associated with, in whole or in part, participant’s involvement with the activity. I certify all answers and information provided on this registra-tion form are to the best of my knowledge true and correct throughout the activity. I shall inform the recreation council in writing if any information provided in this registration form is incorrect or changes through the course of the activity. I shall present a government-issued photo identification card including, but not limited to, my drivers license, passport, or United States Visa to the activity representative for review, if requested, at the time I submit this Registration Form to the recreation council.

Signature of Participant (if over 18) OR of parent/guardian (if under 18):________________________________________________ Date: ______________

Print Name of Signatory: ____________________________________________________________Relationship to Participant: ________________________

REGISTRATION INFORMATION MAIL COMPLETED REGISTRATION FORM AND CHECK (s)

(separate check for each camp please) MADE PAYABLE TO ‘HZRPC’ TO:

HEREFORD RECREATION OFFICE—SUMMER CAMP

17301 YORK ROAD PARKTON, MD 21120

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