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Upper Providence Township Summer Recreation Program

July 7 - August 1

8:30 AM to 11:30, Monday -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 four-week program is $125. 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, snack and sunscreen applied.

If you have any questions, please contact 610-565-4944.


Child’s name: ______________________________ Phone#____________________

Address: ____________________________________________________________

Date of Birth: _______________________ Grade entering September 2014: _______

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: _______________________________________





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