Roseland Recreation Department
973/403-6822
Mayor John Duthie
2015 SCRAM (With the Camp Atmosphere)
Arts and Crafts * Sports * Games * Clinics/Entertainment * Special Trips for Roseland Boys and Girls
(GRADES 1-9) Summer Playground
Doors open at 8:30 a.m. SHARP and close 1:00 p.m. SHARP
Camp is located at Bond Force Memorial Park, 298 Eagle Rock Avenue, Roseland
(All grades will be dropped off at the First Aid Squad building at the rear of the park.)
When: Wed. June 24th – Tues. August 4th Monday through Friday – (rain or shine)
(NO playground Friday, July 3rd)
Cost: $300.00 per child for the entire 6-week program – Includes a T-shirt!
DEADLINE: Friday, June 12th or when the maximum number of participants is reached (whichever comes first), all others will be placed on a Waiting List, and added if space becomes available. Registrations will be done on a “first-come, first-served” basis.
REFUND POLICY APPLIES - There is a $25.00 processing fee on all refunds.
MAKE CHECKS PAYABLE TO: BOROUGH OF ROSELAND -
Mail or walk into: ROSELAND RECREATION DEPARTMENT, 140 Eagle Rock Avenue, Roseland, NJ 07068
PARENTAL NOTES: 1. There may be up to six day trips. Some trips, if not all, may extend playground time. A nominal fee may be charged for each special trip. 2. Children will not be allowed to leave the playground without written permission. A parent/guardian must be present to sign in and sign out a child every day. 3. Packet pick-up day (shirts, policy, schedules and trip forms) at Roseland Recreation is on or after Monday, June 22nd.
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EACH SCRAM PARTICIPANT NEEDS A FORM DETACH HERE OFFICE USE ONLY-DO NOT WRITE BELOW
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CASH CHECK # AMOUNT DATE REC’D.
CHILD’S NAME ______E-MAIL ADDRESS ______
ADDRESS ______HOME PHONE ______
EMERGENCY PHONE______GRADE (FALL ’15) ______
(Circle Shirt Size) Youth: S ____ M____ L____ Adult: S ____ M ____ L ____ XL ____
DOES YOUR SON/DAUGHTER HAVE ANY HEALTH CONDITION(S) THE STAFF SHOULD KNOW ABOUT? No_____ Yes, Explain ______
The Recreation Department recommends the disclosure of relevant health information. Unless the Roseland Recreation Department is notified in writing, staff will be forwarded all information on the Registration Form, including any health conditions.
Child Photo / Video / Release Form
I grant permission for the Borough of Roseland, Roseland, New Jersey to use photograph(s)/moving image(s) of my child participating in Borough programs and/or activities for promotional purposes. I understand that photographs or recordings may be utilized by the Borough at its discretion for materials including, but not limited to: newsletters, brochures, television, video tape and flyers. Photographs sent to the local newspaper may have names noted. There will be no valuable consideration paid as a result of this activity. Yes ___ No ___
Parents/Adult’s signature allowing participation and waiving claims that may result from an injury due to a summer playground activity. In addition, the participant will abide by the Program Policy and all other Rules and Regulations implemented.
SIGNATURE (PARENT/GUARDIAN) DATE
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WE ARE LOOKING FOR PROGRAM SPONSORS. PLEASE CHECK HERE IF INTERESTED ______
For more information turn to Comcast Channel 35 or Verizon Channel 46, check out our Website
at www.roselandnj.orgor look in “The Progress” newspaper.