Summer Recreation Program
By Marilyn A. Herbeck
Apr 25, 2006, 16:00

The City of Staunton will again sponsor a summer recreation program for the youth of the Community. The cost is $5.00 per ten (10) day session. Activities will be conducted five (5) days per week for two (2) weeks, and will take place at the Staunton Elementary School and City Park on Montgomery Street from 9:00-11:30 a.m.

The program will focus upon three areas: Physical Activities, Handicrafts/Art, Science/Environment, and Safety. A local teacher will direct each area.

Students in grades 1-4 for the 2007-2008 school year are eligible to participate in the program.

A completed registration form and $5.00 payment must be delivered to the City Clerk’s office in Staunton for the student to participate. Students should report to the Community Room at the Elementary School the first day of each session. There will be a small snack and drink provided each day for all children participating in the program.

Session #1 June 11th-15th Session #2 July 9th-13th
June 18th-22nd July 16th-20th


_______Session #1 _________Session #2

2007-2008 Grade Placement 1st 2ed 3rd 4th (circle)

Participant’s name __________________________________________________
Please print
PARENT/GUARDIAN CONTACT

Name:_________________________________________________________
Relationship
Address:__________________________________________ City: ________________

Phone:(H)_________________________ (W) _________________________

Emergency contact:

Name: ____________________________________ Phone: ____________________

Important Medical Information: _____________________________________________

________________________________________________________________________

As a parent/guardian, I understand that if a serious illness/injury develops, medical or hospital care will be given. I further understand that in case a serious illness/injury, I will be notified. However, if it is impossible to contact me, I give my permission for emergency treatment to be administered as recommended by an attending physician.

Signed: _________________________________ Date: _________________
Parent/Guardian


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