2008 UPPER MOUNT BETHEL SUMMER RECREATION

DATES:  Monday, June 23-Friday, July 25

TIMES &             Monday, Wednesday, Friday   9am-12 noon

LOCATIONS:     Bangor Area Middle School

                            *We will not meet on Friday, July 4,2008

                               Tuesday, Thursday     10am-12 noon

                               Evergreen Village Pool

WHO CAN COME?  Students in Bangor Area School District entering

                                     Grades 1-7

COST:  $45/child(resident of UMBT & Portland)

              $50/child(resident of East Bangor, Bangor, Washington Twp.,

                            LMBT, Roseto)                                                    

              $25/child for each additional child per family

Please return this form along with a check made out to: UMBT Recreation

Send to:  Christina Hagan, 124 Washington Blvd., Bangor, PA 18013                   

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NAME_______________________________________AGE_____GRADE

ADDRESS___________________________________________________

                  ___________________________________________________

HOME PHONE__________________CELL PHONE__________________

FRIEND/GRANDPARENT PHONE_______________________________

ALLERGIES/MEDICATIONS____________________________________

SWIMMING ABILITY(CIRCLE ONE)     Poor        Good          Very  Good

I understand that Upper Mount Bethel Township will not be responsible for any medical expense that may be incurred by the children participating in the program.  I give the above named child permission to participate in the activities of the UMBT Recreation Program, and I take full responsibility for any medical expenses that result from injury during the program.

Parent Signature___________________________________Amount paid_______

People Who Have Permission to pick up above named child__________________

__________________________________________________________________