Bus Leaving Nc : 11:15 A.M. Returning to Nc : 2:15 P.M

Date: Wednesday November 8, 2017

BUS LEAVING NC @: 11:15 A.M. RETURNING TO NC @: 2:15 P.M.

*Bus leaving from pool parking lot-Borough of North Caldwell*

All You Can Eat Lunch Buffet includes:

Appetizer: Assortment of Cheeses/Daily Selection of Cold Items, Shrimp

Carving Stations: Prime Rib, Leg of Lamb, Roast Turkey

Soups: Cream of Mushroom, Lobster Bisque, Soup of the Day

Main Course: Fresh Pasta, Fish, Chicken, Veal, Beef, Lamb (prepared in a variety of styles)

Side Dishes: Vegetables, Potato Puree

Dessert: Ice Cream, Fresh Fruit, Chocolate Mousse, Crème Brulee, Cheesecake Pops

Beverage: Coffee/Tea

PRICE: (Senior Club Member) $30.00 or (non-members) $35.00

FORMS ARE DUE BY NOVEMBER 1, 2017 –NO REFUNDS!

Please make checks payable to: Borough of North Caldwell

(Please sign & return with payment to: North Caldwell Recreation Department-141 Gould Avenue ------

Participants Name: ______Address: ______

Cell Phone #: ______Home #:______Emergency #: ______

EMAIL ADDRESS: ______Senior Member: ______or Non-member: ______

Health Conditions and/or Allergies: ______

Waiver and Release of Liability: I, ______, hereby certify that I am in good health and able to participate in the prescribed activity without limitation. Furthermore, I agree to release and hold harmless the Borough of North Caldwell, including its agents, employees, officials and instructors, from all claims and liability arising from participation in the activity, including, but not limited to those arising out of any injury or accident sustained by me in the course of this activity. If any emergency should arise and I am unable to provide consent, and my emergency contact cannot be reached immediately at home or at the emergency telephone number I have provided, I hereby grant Borough and/or medical personnel the authority to take whatever actions by whatever means they deem necessary to safeguard my health and/or welfare. * I comply with North Caldwell’s NO REFUND policy.

Signed:______Print Name: ______Date: ______

The Manor November, 2018 Amount: ______Check #: ______