Upper Providence Township Summer Recreation Program

June 25-July13, 2012
8:30 AM to 11:30, Monday thru Friday
Rose Tree Elementary School

           Registration is now open. Children entering kindergarten through fifth grade are eligible to participate in the program and will be grouped according to age. Activities include arts and crafts, drama, sports, story time, and special event days. Please complete the required registration form below and return it to the municipal building. Registration forms may be dropped off or mailed to 935 North Providence Road, Media, PA 19063. Fee for the three-week program is $100. Please make checks payable to Upper Providence Township.
          We ask that you drop off your child at the kindergarten wing. Campers should come daily with bottled water and sunscreen applied.
         If you have any questions, please contact 610-565-4944.

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Child’s name: ______________________________ Phone#____________________

Address: ____________________________________________________________

Date of Birth: _______________________ Grade entering September 2012: ________

Health information/Allergies/medical conditions/Special Needs::

___________________________________________________________________

Emergency contacts:

Name: _______________________ Phone # ______________ relation to child________

Name: _______________________ Phone # ______________ relation to child ________

Doctor’ Name: _________________________ Phone # _____________

Signature of parent/guardian: _____________________________________