Town of North Haven

Department of Recreation
SUMMER BROCHURE 2024

RECREATION PROGRAM REGISTRATION

Resident Mail In – April 22
(Postmarked no earlier than 4/19)
Resident Walk In – April 29
Non-Resident – May 6
No online registration
Rec@northhaven-ct.gov
203-239-5321 ext. 530

All registrations must include proof of residency, or they will be sent back. Proof of
residency cannot be kept on file. A check is not considered proof of residency.
PARKS AND RECREATION COMMISSION RECREATION DEPARTMENT STAFF
AL CENTONE, Chairman ANDREW DELVECCHIO, Assistant Director/Recreation
ROBERT KOWALEWSKI KATE MEIKLE, Assistant Director/ Pool
FRANK MONTAGNA, Secretary JOHN BIMONTE, Program Coordinator
CHRISTOPHER PAGAN JENNIFER KLEIN, Secretary
KEITH MACDOWALL
MARY LOU STAMP, Vice Chairman
JOAN WALSH

SPECIAL NOTE: All mail in registrations must include proof of residency or they
will be returned. A check is not considered proof of residency. Class participation may
be confirmed by sending a self-addressed, stamped envelope with your registration;
otherwise, you will be notified only if you do not receive your first choice. Sign up
early! There is limited space in all classes and programs.
 Summer Concert Series
2024
Tuesday, May 28 Rich DiPalma Italian/Contemporary

Tuesday, June 4 Beau Bolero Tribute to Steely Dan

Tuesday, June 11 The Bernadettes Dance/Rhythm & Blues/Soul

Tuesday, June 18 Savile Row/Tony V Rock/Pop/Standards

Tuesday, June 25 Signature Band Decades of Dance

Tuesday, July 2 Carrie Ashton ICON Celebrating Legendary Woman in Music

Tuesday, July 9 Classics Doo Wop/50’s/60’s

Tuesday, July 16 Eagles Experience Tribute to the Eagles

Tuesday, July 23 Timmy Maia Motown/Today’s Music

Tuesday, July 30 The Foreigner – Journey Experience Foreigner & Journey Tribute

Tuesday, August 6 Jukebox 45 Show Band Songs of Yesteryear

Tuesday, August 13 Heavy Hitters Pop/Classic Rock

Tuesday, August 20 Rhythm City (Deep Pocket) Pop/Top 40/Rhythm & Blues

Tuesday, August 27 Raise Your Hands Bon Jovi Tribute Band

Tuesday, Sept 3 Avenue Groove Rhythm & Blues/Funk/Pop

POOL INFORMATION
Our pool is getting a new roof. Unfortunately, the pool will be closed while
the work is being done. The roof replacement is now scheduled to begin in
early May and will take a few months. We are unable to provide an exact
timeframe. The pool will stay open as close to the start of construction as
possible, and it will reopen as soon as the work is completed. When or if
there will be summer swimming lessons, they will be publicized on our
Recreation Facebook page and on the town website. As always, you may
call the Rec Center if you have any questions.

POOL SCHEDULE UNTIL POOL CLOSES

Swim is drop in; you do not need to make a reservation.

Mondays:
7:30 - 9:30am Lap Swim Thursdays:
9:30 - 12:30pm Open/Lap swim 7:30 - 9:30am Lap Swim
5:30 - 8:30pm Open/Lap swim 9:30 - 12:30pm Open/Lap swim
5:30 - 7:30pm Open/Lap swim
Tuesdays:
7:30 - 9:30am Lap Swim Fridays:
9:30-12:30 p.m. Open/Lap swim 7:30 - 9:30am Lap Swim
5:30 - 6:30pm Lap Swim only 9:30 - 12:30pm Open/Lap swim

Wednesdays: Saturdays:
7:30 - 9:30am Lap Swim 12:30 - 4:00pm
9:30-12:30pm Open/Lap swim Open/Lap the whole time
6:30 - 8:30pm Open/Lap swim

This schedule is subject to change.

The summer schedule will be similar to the schedule above.
 SUMMER DAY CAMP 2024
For ages 3-13 at the Rec Center
Here comes another fun filled summer at the Rec Center’s Summer Day Camp!
The days will be creatively structured and filled with interesting activities
that are developmentally appropriate for all ages of camper. Our
Summer Camp program provides children with a small counselor to child
ratio, and our supervisory staff is trained in first aid and CPR. The camp
day goes from 8:00 a.m. to 5:00 p.m., Monday through Friday. The daily
camp activities are centered on a weekly theme and include cooperative
group games, arts and crafts, weekly special events, a reading program
and more. Each fun-filled week ends with Pizza Day, so no need to pack
a lunch on Fridays. Each camper will receive a free T-shirt, with a
maximum of two for the summer. Due to construction on the pool
roof, it is unclear when or if the pool will be available for camp
use. Each child must be signed in and out by a parent/guardian and
picked up promptly. THE HEALTH/WAIVER FORM MUST BE COMPLETED
WITH REGISTRATION. Day Camp is open to nonresidents for an
additional $10 per week.

WEEK 1 – June 24 – June 28 Introducing Me! $300

Campers will play games and do activities to celebrate each person’s uniqueness.
Special Event on June 28: Kids favorite Magician Matt Mathews
WEEK 2 – July 1 – July 5 Nature All Around Us $240
No camp on Thursday, July 4 th

Crafts and activities will explore how we coexist with nature.

Special Event on July 5: Talewise - An experience powered by learning & science.
WEEK 3 – July 8 – July 12 Animals Galore $300
An animal themed week
Special Events: Visits from Curious Creatures on July 10 and North Haven Police K-9 Unit
WEEK 4 – July 15 – July 19 Sports! $300
Campers will try their hands at a variety of sports and make sports themed crafts.
Special Event TBA: Inflatable Obstacle Course
WEEK 5 – July 22 – July 26 Community Week $300
Cooperative games and activities.
Special Events: Campardy, an interactive game show with all the bells and whistles on
July 23 and Trip to our Town Historical Society TBA
WEEK 6 – July 29 – August 2 Talent Week! $300
Our annual talent show highlights our week of games, activities, and a dance party.
Special Events: Dance Party August 1 / Talent Show August 2.
 PLAYGROUND CAMP
at Montowese Elementary School
For ages 6-12
Monday, June 24 – Friday, August 2, 2024
No Camp Thursday, July 4, 2024

Camp runs Monday through Friday from 9:00 a.m. to 3:00 p.m.
FEE: $350.00
This program is run on a DROP-IN BASIS offering children the opportunity to interact
with others in various recreational activities. The playground is staffed with a director
and an appropriate number of youth counselors. Our supervisory staff is trained in First
Aid and CPR. Arts & Crafts will be offered at no additional charge. Children 5½ years of
age who have completed kindergarten may register. A letter from the school or a report
card must be shown as proof of completion of kindergarten. Children are required to
wear sneakers to this program! Participants should bring lunch in a cooler and a water
bottle. Each child must be signed in and out daily by their parent/guardian
unless written permission is given directly to the site director indicating the
name of the person that will be signing that child out. Children will not be
allowed to sign themselves in or out unless it is indicated and signed on the
health waiver by that child’s parent/guardian.
PLEASE NOTE: This program is for NORTH HAVEN residents only.

THE HEALTH/WAIVER FORM MUST BE COMPLETED AND RETURNED WITH MAIL-

IN AND WALK-IN REGISTRATION. You will find all the forms you need at the back of
this brochure.

Recreation Office hours Mon. – Fri. 9:00am – 4:30pm & Mon. – Thurs. 6:30 – 8:30pm
 POOL MEMBERSHIP
Annual Memberships (residents only) Valid from July 1 through June 30. Fees are
not pro-rated. Proof of age and residency are required when paying. People who work
full time for the town have the same privileges as residents and may purchase
annual passes. Proof of age and employment are required at the time of
purchase. Corporate Memberships are available to individuals who are fulltime
employees of companies located in the town.
Prices for 2024-2025 New Memberships will be:

ADULT SINGLE for those 18 and over: $85.00

YOUTH SINGLE for ages 17 and under: $75.00
FAMILY OF TWO: $125.00
FAMILY OF 3+: $145.00
SENIOR SINGLE for ages 60 and over: $40.00
SR. COUPLE for ages 60 and over: $50.00
CORPORATE MEMBERSHIP: $310.00
Prices for Membership Renewals will be determined when we
reopen and will be discounted for the duration of the pool closure.
Daily fees for residents who do not have an annual pass: when you sign in be
prepared to show proof of residency. Payment must be made in cash or check.
ADULT: $5.00
SR. CITIZEN: $4.00
CHILDREN: $4.00
*NONRESIDENT GUEST: $10.00
CORPORATE: $10.00
*Please note that nonresidents must be accompanied by a swimming
resident.

ITALY AND ITALIAN WITH ANNA!

In this class you will discover the traditions and culture of Italy
without the expense of a plane ticket! You will explore and learn
the basics of the language, the customs, and the heritage. In
addition, you will receive a typical recipe from one of the regions
of Italy, a gastronomic center of Europe, to try in the comfort of
your own kitchen at home. Sign up for one or more sessions if
you wish. Ciao!
FEE: $100 per Four Week Session
DAY AND TIME: Wednesdays, 5:30-6:30 p.m.
DATES: Session 1 May 1 – May 22
Session 2 June 5 – July 3 (no class June 19th)
Session 3 August 7 - 28
LOCATION: North Haven Rec Center
 SPORTS CAMPS/CLINICS
VOLLEYBALL CAMP
FEE: $180 Nonresidents pay an additional $10
DATES: Monday – Friday, July 22 – July 26
SESSION 1: 8:00-10:30 a.m.
SESSION 2: 11:00 a.m.-1:30 p.m.
INSTRUCTOR: Brianna Kleckner
AGES: Athletes entering grades 5-9
LOCATION: North Haven High School.
Both sessions will complete the same daily activities. Athletes can register
for both sessions.

FENCING CAMP
FEE: $110 Nonresidents pay an additional $10
DATES: Monday – Friday, July 8 – July 12
TIME: 9:00 a.m.-12:00 p.m.
INSTRUCTOR: Jim Harris, Head Coach NHHS Fencing
LOCATION: North Haven High School
AGES: 10-14 years
Beginner fencing students will learn the basics of foil fencing, including
footwork and basic bladework techniques. Fencers will progress from a
basic introduction to the sport of fencing to actual bouting by the end of the
week. Instruction will focus on conditioning, hand / eye coordination, basic
technique, and the rules and practices of the sport. On Friday there will be
a camp competition and parents are encouraged to attend. Basic equipment
is provided. No previous fencing experience required!
 SPORTS CAMPS/CLINICS
RUNNING CAMP
FEE: $120 Nonresidents pay an additional $10
DATES: Mondays, Tuesdays & Thursdays,
July 8 – August 1
TIMES: 6:00-7:30 p.m.
INSTRUCTORS: Ellis Gill – Head Coach
Cross Country, Indoor & Outdoor Track at
Lauralton Hall High School
Christopher DelVecchio – Assistant Coach Cross Country, Indoor &
Outdoor Track at Lauralton Hall High School
LOCATION: NHHS TRACK
AGES: 10 – 18 years

YOUTH TENNIS CLINIC

For Ages 6 – 13 5 Sessions
FEE: $60.00 Nonresidents pay an additional $10
DATE: Saturdays, June 29 – July 27
TIME: 8:30-9:30 a.m. INSTRUCTOR: Bob Migliorini
LOCATION: North Haven High School Tennis Courts off Maple Ave
The objective of the youth tennis clinics are to introduce participants to the
game of tennis and build their skills in the game through a combination of
formal instruction, drills and fun games. The clinics are intended for
beginner and intermediate level players. Formal instruction will be provided
on the following strokes: forehand, backhand, serve, return of serve,
volley, lob and overhead. In addition, participants will learn about tennis
scoring, rules of the game, tennis etiquette, singles play strategy, and
doubles play strategy. Each clinic will start with a warm-up, followed by
formal instruction on a stroke or technique, followed by drills to practice the
stroke or technique, and finally supervised games to apply the teachings in
play situations. Participants should wear sneakers and bring a racquet to
each clinic. Bob Migliorini is the North Haven High School Girls Tennis
Coach. If you have any questions about the clinic, please contact Bob at
rampatlaw@gmail.com. Rain date if needed: August 3.
 SPECIAL OLYMPICS
REGISTRATION DATE: June 18, 2024, 6:00 PM-8:00 PM at
North Haven Recreation Center, 7 Linsley Street

BOCCE
All players must make a minimum of 8 practices.
Wear comfortable clothing and sneakers.
FEES: $10 Make check out to “Treasurer, Town of North Haven.”
$30 Tournament Fee - make payable to SOCT
PRACTICE DATES: Wednesdays & Thursdays, July 10, 11, 17, 18,
24, 25, 31, August 7, 8, 14, 15, 21, 22, 28, 29, and September 4, 5
Schedules will be handed out the first week of practice.
TIME: 5:30 PM – 8:00 PM
LOCATION: North Haven Senior Center, 189 Pool Road, North Haven
COMPETITION DATES: September 7 & 8
COMPETITION LOCATION: CALZI PARK, 100 BRIDGE STREET,
STAMFORD

GOLF
All players must make a minimum of 8 practices.
This is NON-NEGOTIABLE.
Athletes must bring their own golf clubs and should wear comfortable
clothing and sneakers. Athletes will begin with a review of the fundamentals
and then begin play on the course in preparation for the Special Olympics
tournament in September.
FEES: $10 Make check out to “Treasurer, Town of North Haven.”
$30 Tournament Fee - make payable to SOCT
$20.00 for Shirt (if needed) Make payable to SOCT
TIME: Skills: 5:30 PM – 7:30 PM 9-Hole League: 5:00 PM – dusk
PRACTICE DATES: Skills: Tuesdays 9-Hole League Dates: Tuesdays
July 9, 16, 23, 30, August 6, 13, 20, 27 and September 3
LOCATION: Sleeping Giant Golf Course, 3931 Whitney Avenue, Hamden
COMPETITION DATE: Sunday, September 8, 2024 (subject to change)
COMPETITION LOCATION: At Sleeping Giant Golf Course
 SPECIAL OLYMPICS
REGISTRATION DATE: June 18, 2024, 6:00 PM-8:00 PM at
North Haven Recreation Center, 7 Linsley Street

UNIFIED SOFTBALL
Athletes must bring their own glove and wear comfortable clothing and
sneakers.
FEES: $10.00. Make check payable to “Treasurer, Town of North Haven.”
$30.00 Make payable to SOCT
PRACTICE DATES: Mondays, June 24, July 1, 8, 15, 22, 29, August 5, 12,
19, 26, Tuesday, September 3
TIME: 5:30PM – 8:00PM
LOCATION: Blakeslee Field/Grover Wyman Park, 11 Blakeslee Avenue,
North Haven
DIVISIONING TOURNAMENTS: Saturday, August 10
LOCATION: Pratt Whitney Aircraft Club, 200 Clement Rd., East Hartford CT
TOURNAMENT: Saturday and Sunday, September 7 & 8
LOCATION: Pratt Whitney Aircraft Club, 200 Clement Rd., East Hartford CT

For cancellation information for any of these programs, call

the Info-line at (203) 672-0535. For any other questions,
please contact Ria Violano at (203) 627-8948.
 Miss Patsy’s Learn and
Explore Enrichment
Program
For Children Ages 4 - 5
Call or stop by for more detailed information on this wonderful
Pre-K program!
The program follows the school calendar year and is broken into four
sessions. They are run by Miss Patsy who has extensive experience working
as a preschool teacher and as a Religious Education Director.

Mondays, Wednesdays, and Fridays from 9am – 12 pm

The Learn and Explore Program is well balanced socially, emotionally, and
educationally. Children will be encouraged to think, reason, question,
explore and have lots of fun at the same time. The program will be focused
on learning through play and teacher directed activities. They will be
working on language arts, science, math, social studies, art, and physical
education. The students will work on important tasks such as coloring,
cutting, and gluing. They will learn to identify shapes, colors, and work on
independent skills, name writing, and letter and number identification. The
program supports a successful transition to kindergarten.
 PROGRAM REGISTRATION INFORMATION
All program registrations are accepted on a first come, first served basis as follows:

RECREATION PROGRAM REGISTRATION

Resident Mail In – April 22
(Postmarked no earlier than 4/19)
Resident Walk In – April 29
Non-Resident – May 6
Unfortunately, online registration is not available.
If you have any questions, email us at Rec@northhaven-ct.gov or
call (203) 239-5321 extension 530

HOW TO REGISTER VIA MAIL:

1. Fill out one (1) registration form for each person and program.
2. Write one (1) check for each person and program, payable to “Treasurer, Town of
North Haven.”
3. Include proof of residency. Proof of residency must be included every time you
register.

One of the following will be accepted for proof of residency:

Valid CT driver’s license
Lease or mortgage
Two recent utility bills
Voter registration card
Tax bill for real property (real property is building or land. This does
not include motor vehicle and other like taxes)

4. Registration forms must be signed by participant or parent if participant is

under 18 years old.

Class registration will only be confirmed by sending a self-addressed stamped

envelope with your registration, otherwise you will be notified only if you do not
receive your first choice.
The department reserves the right to return any registration with incomplete
information or insufficient proof of residency without processing it.

Mailing address/telephone/email Office hours

7 Linsley Street Mon-Fri 9:00 a.m.-4:30 p.m.
North Haven, CT 06473 Mon-Thurs 6:30 p.m.-8:30 p.m.
Telephone: (203) 239-5321 ext. 530
Rec@northhaven-ct.gov
HOW TO REGISTER IN PERSON:
1. Come to the Recreation Office during business hours.
2. Bring a check or cash to pay for program. We cannot accept partial payments.
3. Bring proof of residency.

One of the following will be accepted for proof of residency:

Valid CT driver’s license
Lease or mortgage
Two recent utility bills
Voter registration card
Tax bill for real property (real property is building or land. This does
not include motor vehicle and other like taxes)

Refund Policy: Refunds will not be issued unless the program is cancelled by the
department, your space can be filled with another registration, or a physician’s note is
provided. Should the department initiate a cancellation of a class after the start of the
program and makeups cannot be rescheduled, a credit will be issued. However, if the
opportunity for makeup is provided, no credit will be issued.

Cancellation Information: In the event of inclement weather or other factors beyond

our control, programs may need to be cancelled. Participants should call the recreation
info-line at (203) 672-0541 if there is any question about cancellations due to
weather conditions.

Residency Defined: Residents are defined as those persons domiciled on a permanent

basis in the town of North Haven or those persons working on a permanent full-time
basis for the town. Individual owners of real property (non-motor vehicle) are included
in this definition. Please note: any person working full-time in the town of North Haven
is considered a resident and is eligible to pay the program’s established resident fee;
this privilege is not extended to the family members of the employee. Those who work
in the town must show proof of full-time employment such as a current pay stub or
letter from the employer at the time of registration.

Special Information: All classes are held at the Mildred A. Wakeley Recreation Center
on Linsley Street, unless otherwise noted. Class location, fees, and instructors are
subject to change. Be sure to sign up early because there is limited space in all classes
and programs.

Inclusion Policy: The Recreation Department welcomes the participation of all

individuals, including those with disabilities, into our programs. We will comply with the
spirit and intent of the Americans with Disabilities Act (ADA) in making reasonable
accommodations for those individuals who need them. Please inform us of any special
needs at the time of registration. We would like at least two weeks prior to the start of
the program to arrange for accommodations.
 GENERAL REGISTRATION FORM
See detailed directions in preceding pages
-----------------------------------------------------------------------------------------------------------------------------------------
PARTICIPANT’S
NAME___________________________________________________________________________________________

DATE OF BIRTH______________________AGE__________PHONE ________________________________________

ADDRESS_________________________________________TOWN & ZIP CODE_______________________________

PROGRAM: 1ST
CHOICE_____________________________________________DAY_____________________TIME____________

2ND CHOICE_____________________________________________DAY_____________________TIME____________

WAIVER HOLD HARMLESS

The undersigned individual and/or as parent or guardian of the above-named child do hereby agree to waive,
release, and hold harmless the Town of North Haven and its agents and employees from any and all causes of
action including injury and property damage. The North Haven Recreation Department may videotape or take
pictures of participants enrolled in recreation activities, classes, or programs. These photos and/or videotapes
may be used for promotional purposes. I will allow my child’s name, likeness, and photographs for the purposes
of publicity in any media.

SIGNATURE_____________________________________________________________DATE____________________

DID YOU INCLUDE THE FOLLOWING?

SEPARATE CHECKS______ PROOF OF RESIDENCY______ SIGNATURE______ 2 ND CHOICE______

OFFICE USE ONLY: CHECK#____________________RECEIPT#________________________

-----------------------------------------------------------------------------------------------------------------------------------------
GENERAL REGISTRATION FORM
See detailed directions in preceding pages
-----------------------------------------------------------------------------------------------------------------------------------------
PARTICIPANT’S
NAME___________________________________________________________________________________________

DATE OF BIRTH______________________AGE__________PHONE ________________________________________

ADDRESS_________________________________________TOWN & ZIP CODE_______________________________

PROGRAM: 1ST
CHOICE_____________________________________________DAY_____________________TIME____________

2ND CHOICE_____________________________________________DAY_____________________TIME____________

WAIVER HOLD HARMLESS

The undersigned individual and/or as parent or guardian of the above-named child do hereby agree to waive,
release, and hold harmless the Town of North Haven and its agents and employees from any and all causes of
action including injury and property damage. The North Haven Recreation Department may videotape or take
pictures of participants enrolled in recreation activities, classes, or programs. These photos and/or videotapes
may be used for promotional purposes. I will allow my child’s name, likeness, and photographs for the purposes
of publicity in any media.

SIGNATURE_____________________________________________________________DATE____________________

DID YOU INCLUDE THE FOLLOWING?

SEPARATE CHECKS______ PROOF OF RESIDENCY______ SIGNATURE______ 2 ND CHOICE______

OFFICE USE ONLY: CHECK#____________________RECEIPT#________________________

 GENERAL REGISTRATION FORM
See detailed directions in preceding pages
-----------------------------------------------------------------------------------------------------------------------------------------
PARTICIPANT’S
NAME___________________________________________________________________________________________

DATE OF BIRTH______________________AGE__________PHONE ________________________________________

ADDRESS_________________________________________TOWN & ZIP CODE_______________________________

PROGRAM: 1ST
CHOICE_____________________________________________DAY_____________________TIME____________

2ND CHOICE_____________________________________________DAY_____________________TIME____________

WAIVER HOLD HARMLESS

The undersigned individual and/or as parent or guardian of the above-named child do hereby agree to waive,
release, and hold harmless the Town of North Haven and its agents and employees from any and all causes of
action including injury and property damage. The North Haven Recreation Department may videotape or take
pictures of participants enrolled in recreation activities, classes, or programs. These photos and/or videotapes
may be used for promotional purposes. I will allow my child’s name, likeness, and photographs for the purposes
of publicity in any media.

SIGNATURE_____________________________________________________________DATE____________________

DID YOU INCLUDE THE FOLLOWING?

SEPARATE CHECKS______ PROOF OF RESIDENCY______ SIGNATURE______ 2 ND CHOICE______

OFFICE USE ONLY: CHECK#____________________RECEIPT#________________________

-----------------------------------------------------------------------------------------------------------------------------------------
GENERAL REGISTRATION FORM
See detailed directions in preceding pages
-----------------------------------------------------------------------------------------------------------------------------------------
PARTICIPANT’S
NAME___________________________________________________________________________________________

DATE OF BIRTH______________________AGE__________PHONE ________________________________________

ADDRESS_________________________________________TOWN & ZIP CODE_______________________________

PROGRAM: 1ST
CHOICE_____________________________________________DAY_____________________TIME____________

2ND CHOICE_____________________________________________DAY_____________________TIME____________

WAIVER HOLD HARMLESS

The undersigned individual and/or as parent or guardian of the above-named child do hereby agree to waive,
release, and hold harmless the Town of North Haven and its agents and employees from any and all causes of
action including injury and property damage. The North Haven Recreation Department may videotape or take
pictures of participants enrolled in recreation activities, classes, or programs. These photos and/or videotapes
may be used for promotional purposes. I will allow my child’s name, likeness, and photographs for the purposes
of publicity in any media.

SIGNATURE_____________________________________________________________DATE____________________

DID YOU INCLUDE THE FOLLOWING?

SEPARATE CHECKS______ PROOF OF RESIDENCY______ SIGNATURE______ 2 ND CHOICE______

OFFICE USE ONLY: CHECK#____________________RECEIPT#________________________

 NORTH HAVEN DEPARTMENT OF RECREATION CAMP HEALTH/WAIVER FORM
PROGRAM NAME______________________SITE WEEK/S
NAME OF CHILD____________________________ DATE OF BIRTH_____________
NAME OF PARENT/GUARDIAN___________________________________________
ADDRESS HOME PHONE_________________ WORK PHONE___________________
CELL PHONE___________________BEST EMAIL TO USE:____________________________________
SCHOOL AND GRADE COMPLETED IN JUNE
In the event of emergency, list name, addresses, and phones of parent, guardian, or another responsible individual
available during the program hours:
NAME___________________________________RELATIONSHIP TO CHILD______________________
ADDRESS________________________________PHONE_____________________________
NAME___________________________________RELATIONSHIP TO CHILD_____________________
ADDRESS PHONE_____________________________
CHILD'S PHYSICIAN PHONE: CHILD’S DENTIST PHONE:
HOSPITAL OF CHOICE:________________________________________
I give permission to the staff of the Department of Community Services and Recreation to administer emergency first
aid and in the event it becomes necessary to transport my child by ambulance to the hospital listed above.
o Yes o No
Please list any medical and/or physical condition, which may affect your child's activities or require us to modify
activities appropriately.
MEDICAL CONDITIONS/PLEASE CHECK ALL THAT APPLY:
SEIZURE HEARING
o Yes o Yes
o No o No
ASTHMA VISION
o Yes o Yes
o No o No
DIABETES ADHD/ADD
o Yes o Yes
o No o No
CARDIAC ALLERGIES
o Yes o Yes
o No o No
OTHER/PLEASE EXPLAIN:___________________________________________________________
If yes to any of above please list here medication needed:____________________________________
If medication needed at camp ie epipen or inhaler; you must provide a copy of the medication authorization form.
(*Please be sure to sign here and below)______________________________________
*Signature of Parent or Guardian
WAIVER, HOLD HARMLESS
The undersigned individual and/or as parent or legal guardian of the above-named child do hereby agree to waive,
release and hold harmless the Town of North Haven and its agents and employees from any and all causes of action
including personal injury and property damage resulting from participation in the above named program.
Please place your initials next to the statements which apply to your child.
SWIMMING
I give permission for my child to participate in swimming at the Walter J. Gawrych Community Pool.
Please indicate your child's swimming ability.
Swimmer (child can swim a minimum of one pool length unassisted)
Beginner (can swim without assistance, but may need it at times)
Non-Swimmer (needs flotation device)
I do not give permission for my child to swim.
TRANSPORTATION (DOES NOT APPLY TO DAY CAMP)
I hereby give my child permission to walk or ride his/her bicycle to and/or from the program site and understand
that it is my child's responsibility to sign him/herself in and out of the program each day or portion thereof. The
Department of Community Services and Recreation is not responsible for my child while he/she is on their way
to/from the program site.
I will transport my child to/from the program in my own vehicle.
My signature constitutes agreement with the information as indicated above.

_________ ________________________________

Date *Signature of Parent or Guardian

 NORTH HAVEN DEPARTMENT OF RECREATION CAMP HEALTH/WAIVER FORM
PROGRAM NAME______________________SITE WEEK/S
NAME OF CHILD____________________________ DATE OF BIRTH_____________
NAME OF PARENT/GUARDIAN___________________________________________
ADDRESS HOME PHONE_________________ WORK PHONE___________________
CELL PHONE___________________BEST EMAIL TO USE:____________________________________
SCHOOL AND GRADE COMPLETED IN JUNE
In the event of emergency, list name, addresses, and phones of parent, guardian, or another responsible individual
available during the program hours:
NAME___________________________________RELATIONSHIP TO CHILD______________________
ADDRESS________________________________PHONE_____________________________
NAME___________________________________RELATIONSHIP TO CHILD_____________________
ADDRESS PHONE_____________________________
CHILD'S PHYSICIAN PHONE: CHILD’S DENTIST PHONE:
HOSPITAL OF CHOICE:________________________________________
I give permission to the staff of the Department of Community Services and Recreation to administer emergency first
aid and in the event it becomes necessary to transport my child by ambulance to the hospital listed above.
o Yes o No
Please list any medical and/or physical condition, which may affect your child's activities or require us to modify
activities appropriately.
MEDICAL CONDITIONS/PLEASE CHECK ALL THAT APPLY:
SEIZURE HEARING
o Yes o Yes
o No o No
ASTHMA VISION
o Yes o Yes
o No o No
DIABETES ADHD/ADD
o Yes o Yes
o No o No
CARDIAC ALLERGIES
o Yes o Yes
o No o No
OTHER/PLEASE EXPLAIN:___________________________________________________________
If yes to any of above please list here medication needed:____________________________________
If medication needed at camp ie epipen or inhaler; you must provide a copy of the medication authorization form.
(*Please be sure to sign here and below)______________________________________
*Signature of Parent or Guardian
WAIVER, HOLD HARMLESS
The undersigned individual and/or as parent or legal guardian of the above-named child do hereby agree to waive,
release and hold harmless the Town of North Haven and its agents and employees from any and all causes of action
including personal injury and property damage resulting from participation in the above named program.
Please place your initials next to the statements which apply to your child.
SWIMMING
I give permission for my child to participate in swimming at the Walter J. Gawrych Community Pool.
Please indicate your child's swimming ability.
Swimmer (child can swim a minimum of one pool length unassisted)
Beginner (can swim without assistance, but may need it at times)
Non-Swimmer (needs flotation device)
I do not give permission for my child to swim.
TRANSPORTATION (DOES NOT APPLY TO DAY CAMP)
I hereby give my child permission to walk or ride his/her bicycle to and/or from the program site and understand
that it is my child's responsibility to sign him/herself in and out of the program each day or portion thereof. The
Department of Community Services and Recreation is not responsible for my child while he/she is on their way
to/from the program site.
I will transport my child to/from the program in my own vehicle.
My signature constitutes agreement with the information as indicated above.

_________ ________________________________

Date *Signature of Parent or Guardian