CRYSTAL SPRINGS - East Brunswick

HOUSEHOLD INFORMATION
Name (First & Last)
Relationship to Participant
Address
City, State, Zip
Home Phone
Work Phone
Cell Phone
Email
REQUIRED – PROOF OF AGE
Please include a copy of child's birth certificate or
other legal documentation verifying age. Proof of
age is required for first time registrants.
USE ONE REGISTRATION FORM PER HOUSEHOLD
Every participant you register on this form MUST reside at the same household; if different, use another form
If required information is not submitted, your registration will be returned
PARTICIPANT INFORMATION
ACTIVITY REGISTRATION FORM
Who should complete this section?
• A Parent/Guardian registering a child/teen for a program
• A Parent/Guardian registering a family for a trip
• An Adult Participant registering for a program or trip
MOTHER/GUARDIAN/ADULT PARTICIPANT FATHER/GUARDIAN/ADULT PARTICIPANT
(circle one) (circle one)
Participant’s Name Current Birthdate Program Start
First Last Grade M / D / Y Sex Program/Activity Name Code Mo/Day Fees
CALL 732-390-6797 FOR PROGRAM INFORMATION
REQUIRED – PROOF OF RESIDENCY
Residents Only - Proof of residency MUST be
submitted every time you register for a program, even
if this information has been provided in the past.
Has your address changed since last registration? ❏ Yes ❏ No Are you an East Brunswick resident? ❏ Yes ❏ No
With whom does the participant reside? ___________________________________________________
Registration
Begins March 1
Mail-In or Online
See p. 30
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This form does not guarantee a spot in the program desired. Registration is first come, first served. TOTAL FEES $ __________
Form of Payment: ❏ Cash (do not mail cash)
❏ Check (separate checks for each program and participant) payable to Twp. of East Brunswick
WAIVER FOR PARTICIPANT AND/BY PARENT
I hereby waive and release all rights and claims that I or my minor child, my heirs, executors, and administrators may have now or that may come into existence
against the Township of East Brunswick, its employees, officials, agents, successors, and assigns as a result of or in connection with any activity sponsored by East
Brunswick Recreation. I hereby acknowledge that my registration fee for any East Brunswick Recreation program does not include or entitle myself or my child to
payment of medical expenses that may arise out of mine or my child’s participation in any Recreation program. I acknowledge further that I assume responsibility
for myself or my child’s medical expenses. I hereby acknowledge that East Brunswick Recreation may/may not (cross out one) use myself or my child’s photograph
or likeness, and mine or my child’s name in connection with public presentations, advertising, publicity, and promotional efforts relating to recreation activities.
Signature _________________________________ ________Date _________ My relationship to participant(s): ❏ Parent ❏ Guardian ❏ Participant
Mail to: Department of Recreation, 350 Dunhams Corner Road, East Brunswick, NJ 08816-2656
Call 732-390-6797 • www.eastbrunswick.org
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