Community

HACKETTSTOWN COMMITTEE FOR CRIME PREVENTION (HCCP)

TEEN NIGHT POOL PARTY REGISTRATION

2015

THIS FORM MUST BE COMPLETED AND PRESENTED BY A PARENT IN ORDER TO ATTEND

2015 Pool Parties are held on the following dates from 7-9 PM at the Hackettstown Pool: June 26, July 2, 7,16, 23, 30, and August 6. All are Thursdays except for June 26, (Friday) and July 7 (Tuesday).

Please circle your child’s age, grade he or she is entering, school, and district:

AGE: 10 11 12 13 14 15 16 17 18

GRADE: 6 7 8 9 10 11 12

SCHOOL: High School Middle School

DISTRICT: Hackettstown Allamuchy Great Meadows

PLEASE PRINT CLEARLY

STUDENT NAME: LAST:___________________________ FIRST:___________________________

ADDRESS:______________________________________CITY_______________________________

PARENT/GUARDIAN NAME: __________________________________________________________

HOME PHONE____________________________P/G CELL PHONE __________________________

EMERGENCY CONTACT NAME _______________________________________________________

EMERGENCY CONTACT NUMBER _____________________________________________________

Does your child have any special health or medical concerns? Circle: NO YES

If yes, please explain: ________________________________________________________________

By granting permission for my child to participate in the HCCP Teen Nights. I agree that:

· Registrants must sign in for each Teen Night at the registration/sign in table and are expected to remain for the entire evening. Participants who leave will not be readmitted that evening.

· Student ID is required for admission. Notes will not be accepted after the first attendance.

· HCCP representatives and security reserve the right to deny a student admission.

· Those not registered must do so at the registration/sign in table and be accompanied by a parent.

· Registrants will comply with the basic...