Card to be used for future 2010 camp payments? Yes_______ No____________

PENN-TRAFFORD AREA RECREATION COMMISSION

2001 Municipal Ct. Hours: Mon-Fri, 9:00am-4:00pm PO Box 452 www.PTARC.org Harrison City, PA 15636 www.facebook.com/ptrecreation 724-744-2171, ext. 204 or 205

2010 Summer Day Camp Registration Participant Name ____________________________________________________ Age Birthdate Address ___________________________________________________________ City __________________ Zip ______________ Please circle where you live: Penn Borough Manor Trafford Penn Township Non-Resident Parent’s Name Daytime Phone Evening/Cell Phone Emergency Contact/Permission to Pick-Up Child: Name Phone during camp hours Name Phone during camp hours Participant medical conditions or allergies

Sessions Attending: _____Session 1: June 14-18 _____Session 2: June 21-25 _____Session 3: June 28-July 2 _____Session 4: July 12-16 _____Session 5: July 19-22 _____Session 6: July 16-30 _____Session 7: August 2-6 _____Session 8: August 9-13   

Adult participant signature required below. Parent signature required below for all participants under the age of 18. The undersigned individual (parent or guardian if under age 18) represents that the registrant is in good health and can participate in the above listed activity and with prior knowledge of the physical nature of the activity releases Penn-Trafford Area Recreation Commission (PTARC), and Depart-ment, the Penn-Trafford School District, the Borough of Manor, the Borough of Penn, the Borough of Trafford, Penn Township, and/or its affiliates or subsidiaries, officers, directors, agents, or employees from any and responsibility for injury to the registrant through negligence or otherwise while he/she is participating in the activity. The parent, guardian, or participant assumes all risks inherent in the activity and will hold the Penn-Trafford Area Recreation Commission and Department, the Penn-Trafford School District, the Borough of Manor, the Borough of Penn, the Borough of Traf-ford, Penn Township, and/or its affiliates or subsidiaries, officers, directors, agents, or employees harmless from any and all claims or causes of ac-tion that may arise from this activity. The undersigned individual also hereby gives permission to Penn-Trafford Area Recreation Commission to use photographs of the participant for the promotion of Penn-Trafford Area Recreation events and programs. The participant agrees to hold the Penn-Trafford Area Recreation Commission, the Penn-Trafford School District, the Borough of Manor, the Borough of Penn, the Borough of Trafford, Penn Township, and/or its affiliates or subsidiaries, officers, directors, agents, or employees free and harmless from liability of any nature. _______________________________________________________________________________________________ *PARTICIPANT OR PARENT SIGNATURE DATE

MasterCard & Discover now accepted! Fax form to 724-744-2172

Credit Card Number: ____________________________________ Exp. Date ____ /____ MasterCard Discover

By signing below I agree to pay PTARC for the amount above and understand that a Third Party convenience fee will apply to my trans-action in order for my town/city/state to accept payment via credit card. I further agree that such convenience fee shall billed to my credit card by Nationwide Payment Solutions (NPS) as a separate transaction and equal to *2.45% ($1.50 minimum) of the total amount being paid. Nationwide Payment Solutions is an authorized Level 1 PCI-DSS third party processor of regulated convenience fees. X _______________________________________________________

for students entering 1st‐6th grade  

Sports!  Games!  Drama!  Crafts!  Special Events!  Trips!  Special Guests!  Music!  

Weekly themes and a variety of activities will keep kids busy all summer!   Bring a bag lunch, water bottle and sunscreen daily. 

 

Location:  PTARC/Shelley Proskin Recreation Center, Rt. 130 Level Green  

Time:   Monday‐Friday, 8:00am‐4:00pm  

Dates:   Session 1‐‐June 14‐18  Session 2‐‐June 21‐25  Session 3‐‐June 28‐July 2  

    Session 4‐‐July 12‐16   Session 5‐‐July 19‐22  Session 6‐‐July 26‐30  

    Session 7‐‐August 2‐6    Session 8‐‐August 9‐13  

Fee:    PTSD Residents  $79/week  Non‐Residents  $95/week       →Pre‐registration required, 1st week fee due at time of registration     →Remainder due  the Friday before next participation     →Daily admission may be available, call PTARC office for details  

To register, please complete the form below and return with 1st week fee to: PTARC, PO Box 452, Harrison City, PA  15636       *Make checks payable to PTARC*