Dad Cell#: MY CHILD HAS MY PERMISSION TO WALK TO AND FROM CAMP: Pare n 11 Guardian Signature

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2015 Summer Plus Teen Travel Camp Application Township of Denville Recreation Department 1 St. Mary's Place Denville, NJ 07834 Phone: 973-625-8300 ext. 238 Email: denvilleteentravel@yahoo.

1 2015 Summer Plus Teen Travel Camp Application Township of Denville Recreation Department 1 St. Mary's Place Denville, NJ Phone: ext denvilleteentravel@yahoo.com PLEASE PRINT ALL INFORMATION CLEARLY IN INK *ALL INCOMPLETE APPLICATION FORMS WILL BE RETURNED* Open Registration will begin on Monday, March 16, 2015 Camper's Name: Age (as of June 2015): Grade child will be entering (as of September 2015): s" ~ Allergies: MY CHILD HAS MY PERMISSION TO WALK TO AND FROM CAMP: Pare n 11 Guardian Signature EMERGENCY CONTACTS/PEOPLE AUTHORIZED TO PICK UP MY CHILD: 1. Name: Phone #: ~ Name: Phone#: PLEASE NOTE: If any person other than those listed above is to pick up a camper, a written note MUST be sent in that morning with the child. Please Read and Review the following camp policies: Hold Harmless Agreement: Dad Cell#: I waive and release all rights and claims for damages against Denville Township, the Recreation Department, the Recreation Director, the Denville Board of Education, and any employees and agents for any and all injuries, which may be suffered by the above, named individual while participating in the activity. I understand that all injuries must be reported immediately to the Recreation Department. I also realized that Denville Township, The Denville Recreation Department, and the Denville Board of Education do not have medical or accident insurance to cover the above named individual or any other participants. I further certify that all information on this form is true. Parent Signature & Date

Payment and Refund Information: Payments may be made by cash, check or money order made payable to the Township of Denville. *Half of your payment must be paid on the day of registration.

2 Payment and Refund Information: Payments may be made by cash, check or money order made payable to the Township of Denville. *Half of your payment must be paid on the day of registration.* The remaining balance of your payment is due no later than June 1st No refunds will be given on partial payments. Returned Check Policy: A $30.00 processing fee will be charged to all returned checks. All fees and payments must be paid in CASH or Certified Check. Refund and Cancellation Policy: A $25.00 processing fee will be deducted from your total refund. after June 1st. Trips are non-refundable. No refunds will be given Discipline Policy: At Denville Recreation's Summer Plus Teen Travel Program we seek to provide a safe and fun environment where children can enjoy themselves. The Camp staff is very patient and tolerant. However, the camp does not tolerate behaviors that endanger the welfare of its campers or staff members. Any form of fighting will not be tolerated; this includes biting, kicking, scratching, punching, spitting, use of illegal drugs and alcohol, the carrying of dangerous weapons, bullying, etc. If a child exhibits any of these behaviors, Denville Recreation reserves the right to expel the child from camp without a refund. Media Policy: On occasion campers may be photographed while participating in summer camp activities. I understand that these pictures may appear on the Denville web page and/or in publicity or brochures marketing Denville Recreation programs and facilities. I understand that there are no rights granted to me to inspect or approve photographs prior to publication. Names will not be published with any pictures that are used. Check if applicable: My child has a disability, as defined by the ADA, and may need reasonable accommodations in order to participate in the Summer Plus Teen Travel Camp Program. I have read and understand all of the above information and policies. Parent/Guardian Signature {required): Date

DENVILLE TEEN TRAVEL CAMP INFORMATION SHEET- TRIPS SESSION ONE MONDAY, JULY 6th FRIDAY, JULY 17TH COST $590.

3 DENVILLE TEEN TRAVEL CAMP INFORMATION SHEET- TRIPS SESSION ONE MONDAY, JULY 6th FRIDAY, JULY 17TH COST $ Monday, July 6th Funplex (East Hanover, NJ) - The Funplex is an indoor amusement center, featuring over 100,000 square feet of fun! Attractions include: Splashplex waterpark, foam frenzy, go- karting, lazer tag, bumper cars and a state of the art arcade! Please pack a lunch or bring money to purchase at the concession stand. Arrive: 9am Pick up: 3pm Tuesday, July ih- Camel Beach (Tannersville, PA)- Campers will spend a full day at Pennsylvania's largest waterpark! There are over 37 different rides and slides in the park! Lunch is on your own at the park; bring cash to purchase your lunch. Arrive: 9am Pick up:4 pm Wednesday, July gffi High Point State Park (Wantage, NJ)- At the highest point in New Jersey, campers will have the chance to climb more than 200 stairs to see the views from the top of the monument. We will then spend the rest of the day at the lake and hiking the more than 50 marked trails. Please bring a bagged lunch. Thursday, July gtn Pyramid Mountain (Montville, NJ)- Campers will experience a guided tour up to tripod rock, a 16 ton boulder balanced on top of 3 smaller boulders. We will eat on the trail, please bring a bagged lunch. Friday, July 10th- Branchburg Sports complex (Branchburg, NJ) Campers will spend the day in the 9,000 square foot, four level interactive laser tag arena. Campers will then have some time to spend on the open fields and in the gymnastics area. Lunch will be included.

Monday, July 13th Mt Freedom Mini golf and Disc Golf - (Randolph, NJ) Campers will spend the morning playing mini golf at a fun yet challenging course for part of the day.

4 Monday, July 13th Mt Freedom Mini golf and Disc Golf - (Randolph, NJ) Campers will spend the morning playing mini golf at a fun yet challenging course for part of the day. Then, they will participate in 9 holes of the new Frisbee disc golf game. Lunch will be included. Tuesday, July 14tn -Great adventure- (Jackson, NJ)- Considered New Jersey's largest and most popular theme park, campers will enjoy a variety of rides and activities. Lunch is on your own at the park; bring cash to purchase. Arrive: 8:30 am Wednesday, July 15th Thursday, July 16tn Bowling and Movie- (Rockaway, NJ) Campers start their day at Rockaway lanes to bowl a few games. We will then head to AMC in Rockaway to watch a movie TBD as the date gets closer. We will stop at a local restaurant for lunch, please bring cash to purchase your lunch. Somerset Patriots baseball game- (Bridgewater, NJ)- Campers will travel to watch the Somerset patriots take on the Camden River sharks in an independent included with ticket. Pick up: 5:30 pm league match up. Lunch is Friday, July 1 ih- Cooks Pond (Denville, NJ) Campers will enjoy a last day of camp celebration at Cooks Pond. Games and swimming at a lifeguarded beach will be available to campers all day. Pizza will be provided that day. Drop off and pick up are at Cooks Pond! Arrive: 9am Pick up: 3pm

DENVILLE TEEN TRAVEL CAMP INFORMATION SHEET- TRIPS SESSION TWO MONDAY, JULY 20TH FRIDAY, JULY 29TH COST $590.

5 DENVILLE TEEN TRAVEL CAMP INFORMATION SHEET- TRIPS SESSION TWO MONDAY, JULY 20TH FRIDAY, JULY 29TH COST $ Monday, July 20TH - Dave and Busters Restaurant- (West Nyack, NY) - Campers will spend the day playing various arcade games including some brand news games that have come out this year. We will have a lunch buffet intermission. Arrive: 9am Tuesday, July 21st Pocono Tree Top Adventures-(East Stroudsburg, PA) Campers will spend the day up in the trees, climbing, balancing and zipping through the 66 elements of the Pocono TreeVentures Wednesday, July 22nd Medieval Times- (Lyndhurst, NJ)- Campers will sit ring side at a live jousting tournament, and marvel at awe inspiring horsemanship and falconry; all while eating a four course meal. Thursday, July 23rd - Great Wolf Lodge- (Scrotrun, PA) - Campers adventure begins in the massive, 84-degree indoor water park. They will splash the day away in over 79,000 square feet of water-packed excitement, including jaw-dropping slides for thrill seekers. Lunch is included. Arrive: 8:30 am Friday, July 24th Rafting on the Delaware River- (Frenchtown, NJ) Campers will enjoy rafting on the Delaware river, just north of where George Washington historically crossed. Each admission includes a free BBQ meal at "The Famous River Hot Dog Man", halfway down the river next to Adventure Island with picnic tables in the water! Pick up: 5:30 pm ropes course. Great for all levels of outdoor enthusiasts from beginner to expert, the family outdoor aerial forest adventure offers five courses of varying levels of difficulty. Arrive: 8:30 am Pick up: 3pm Pick up:3 pm

6 Monday, July 25tn Rock Climbing and Movie- (Randolph, NJ)- Campers will challenge themselves in the morning by spending some time learning and practicing the basics of rock climbing at an indoor center. We will stop for lunch on the way to the AMC movies in Rockaway. Movie TBD as it gets closer. Tuesday, July 26tn Dorney Park- (Allentown, PA) - Two parks for the price of one! Campers will spend the day enjoying the roller coasters of the amusement park and the refreshing thrill rides of Wild Water Kingdom. Lunch will be at your own cost at the park. Arrive: 8:30 am Pick up: 5:30 pm Wednesday, July 27ffi- Ropes Course at South Mountain Recreation Complex (West Orange, NJ) - This is a challenging yet fun zip lines and tree top adventures will be a great experience for all campers. It's a team and leadership building experience for all. Lunch is on your own at the park. Thursday, July zs'' - Mt. Creek Waterpark- (Vernon, NJ) - This is the area's largest waterpark with over 30 different rides, slides and attractions. From the 99 foot drop of H20 NO! speed slide to the ride down the Colorado River it is a mountain of fun! Pick up: 4 pm Friday, July 29th Cooks Pond (Denville, NJ) Campers will enjoy a last day of camp celebration at Cooks Pond. Games and swimming at a lifeguarded beach will be available to campers all day. Pizza will be provided that day. Drop off and pick up are at Cooks Pond! Arrive: 9am Pick up: 3pm

DENVILLE TEEN TRAVEL CAMP REGISTRATION MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY JULY GTH JULY 7TH JULY 8TH JULY 9TH JULY 10TH FUNPLEX CAMEL BEACH HIGH POINT PYRIMID BRANCHBURG STATE PARK MOUNTAIN

7 DENVILLE TEEN TRAVEL CAMP REGISTRATION MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY JULY GTH JULY 7TH JULY 8TH JULY 9TH JULY 10TH FUNPLEX CAMEL BEACH HIGH POINT PYRIMID BRANCHBURG STATE PARK MOUNTAIN SPORTSPLEX JULY 13TH JULY 14TH JULY 15TH JULY 16TH JULY 17TH MINI GOLF & GREAT PATRIOTS BOWLING AND COOKS ICE SKATING ADVENTURE BASEBALL MOVIE POND JULY 20TH JULY 21 ST JULY 22ND JULY23RD JULY 24TH DAVE AND POCONO TREE MEDIEVAL GREAT WOLF RAFTING ON BUSTERS TOP TIMES LODGE DELAWARE JULY 25TH JULY 26TH JULY 27TH JULY 28TH JULY 291H ROCK CLIMB & DORNEY PARK ZIP LINE MT. CREEK COOKS MOVIE POND ****Trips are subject to change depending on the weather!***** Denville Teen Travel Camp is held in two 2 week sessions. Camp hours are from 9am-3pm daily depending on the trips. Drop off location is Valleyview Middle School, Denville. Friday July 1 ih and Friday, July 29th campers will meet at Cooks Pond. Please circle which session you would like to attend. Monday, July 6th Friday, July lih - Cost $ for both weeks Monday, July zo". Friday, July 29th Cost $ for both weeks Total amount due: ---- Yz due now, balance due by June i" Amount Paid: ---- Check#: ---

8 Denville Recreation Emergency Medical Information. (Last) (First) (Ml) Address ---~-treel) (City,~ (-Smffi) (Zip) Birth Date / / DMale DFemale In the event of an injury, the local Rescue Squad will transport the injured person to the nearest hospital. In case of an EMERGENCY when you cannot be reached, who should be notified? Relationship Other Phone Relationship Other Phone If there has been a custody decision please list the name or names of the person NOT permitted to pick up the child. (Please provide documentation, which will be kept confidential) Before engaging in any physical activity it is advisable to check with a physician regarding any conditions that may limit participation. Should an emergency arise, we need to know the following information: Name of Physician Phone Number (J Circle if you have any of the following: Date of last Tetanus shot Allergies Specific Food Allergies Insect Allergies Medication Allergies Diabetes Seizures Contact Lenses Dentures Explain in detail any circled above: Do you carry an epinephrine pen/kit? DYes ONo Can you self-administer the epinephrine pen? DYes 0 No Is there anything else about your health you would like us to know in case of an emergency? Presently taking any- medications? DYes 0 No If Yes, what? This medical history is correct and complete to the best of my knowledge. Signature of Participant (or parenuguardian) Please PRINT Signature Name Date Please Return To: Denville Recreation Department 1 St. Mary's Place + Denville + New Jersey x Fax Revised 03/2008

2018 Summer Camp Registration Please select which camp your child(ren) will be attending

1515 N. Galloway Avenue Mesquite, Texas 75150 972.216.6260 www.cityofmesquite.com 2018 Summer Camp Registration Please select which camp your child(ren) will be attending Kidz Kamp Sports Camp Camper Information