Registration Packet Available to Residents and Non-Residents - Freehold Township
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Registration Packet Available to Residents and Non-Residents
2021
Camp
Packet
Camper Registration Check List
______ Summer Camp Registration Form—Completed with Parent/Guardian
Signature
______ Camper Medical Form—Completed with Parent/Guardian Signature
______ Code Of Conduct (Must be signed by Camper and Parent/Guardian)
______ 2021 Summer Camp Health Protocols and Program Agreement.
______ Copy of Birth Certificate (for ALL first time campers )
______ Pick up Authorization Form—Completed with Parent/Guardian Signature.
In addition to 3 Emergency Contact Names (including parents’
names) a maximum of 5 additional names will be accepted.
______ Payments in Full- Cash, Check, Money Order or
Mastercard/Visa/Discover/AMEX will be accepted in the Recreation
Office or register online at www.freeholdtownshiprec.com.
**Reminder** $100.00 of every registration is non-refundable.**
______ At this time there will be NO Camp Bus Transportation for the 2021 camp
Season.
Registration will be returned if any of the above items are incomplete or missing.
If you have any questions please call the Recreation Office at 732-294-2190.
Office Hours are Monday—Friday; 8:30 a.m. to 4:30 p.m.SUMMER CAMP 2021
Open to Residents and Non-Residents.
REGISTRATION IS AVAILABLE ONLINE AT WWW.FREEHOLDTOWNSHIPREC.COM.
FOR: Boys and Girls entering Grades Pre-K - 8 in September 2021.
Kiddie Camp participants must be 4 years old by September 30, 2021.
A copy of the child’s birth certificate must be on file with the Recreation Office
for all first time campers.
CAMP DATES: June 28 to August 13 (Monday - Friday, 7 weeks)
CAMP WILL BE CLOSED ON JULY 5TH.
EXTENDED August 16th—20th from 8:30 a.m.—5:30 p.m. for an additional $205.00
WEEK: This week is optional and limited to 100 campers on a first come first serve basis.
LOCATION: Michael J. Tighe Park, 65 Georgia Road, Freehold, NJ 07728
Office Hours are 8:30 a.m. to 4:30 p.m.
CAMP TIMES: Regular Hours: 9:00 A.M. – 3:00 P.M.
Extended Hours: 7:00 A.M. – 3:00 P.M. – EARLY
9:00 A.M. – 6:00 P.M. – LATE
7:00 A.M. – 6:00 P.M. – FULL
REFUNDS: $100.00 of each registration is non-refundable!
There are NO refunds for the full program fee after the first day of camp or for any
camper removed from the program for behavioral or disciplinary reasons.
BUSING: Due to COVID-19—There is NO busing for the 2021 Camp Season.
OPTIONAL Due to COVID-19—There are NO trips scheduled for the 2021 Camp Season.
TRIPS: But we have a full schedule of camp activities on location!
MAILING Freehold Township Recreation, 1 Municipal Plaza, Freehold, NJ 07728
ADDRESS: Attn: Recreation Department
PHONE NUMBER: 732-294-21902021 SUMMER CAMP PRICING
Full payment and completed registration packet must be received by the Recreation Office no later than 4:00 p.m.
the day of the deadline to receive that tiered pricing. Applications received after 4:00 p.m. will be marked with the
following day's date. Be advised that changes to the program; i.e., adding early, late, or full hours to a registration,
will result in the fee charged for that tiered program. For example, enr olling a camper in the ear ly bir d
regular program and then changing to the early, late, or full program on May 12th (Tier II) will result in the Tier II
fee being charged for the camper’s registration.
Registrations received via the mail will be marked on the date the Recreation Office receives the completed packet.
The Recreation Office is not responsible for any applications lost in the mail.
Registrations received with incomplete information, including medical information and/or first time camper birth
certificates, will not be processed or marked as "received" until all forms are completed.
TIER I - Early Bird Registration: Now – March 30, 2021
Payment must be made in full at time of registration.
Residents Non-Resident Fee
Regular (9 a.m. - 3 p.m.) $ 980.00 per child $ 1,190.00 per child
Morning Care (7 a.m. - 3 p.m.) $ 1,205.00 per child $ 1,415.00 per child
After Care (9 a.m. - 6 p.m.) $ 1,280.00 per child $ 1,490.00 per child
Full (7 a.m. - 6 p.m.) $ 1,455.00 per child $ 1,665.00 per child
TIER II - Registration: March 31– May 20 , 2021
Payment must be made in full at time of registration.
Residents Non-Resident Fee
Regular (9 a.m. - 3 p.m.) $ 1,165.00 per child $ 1,375.00 per child
Morning Care (7 a.m. - 3 p.m.) $ 1,390.00 per child $ 1,600.00 per child
After Care (9 a.m. - 6 p.m.) $ 1,465.00 per child $ 1,675.00 per child
Full (7 a.m. - 6 p.m.) $ 1,640.00 per child $ 1,850.00 per child
Late Registration from May 21 – June 4, 2021
Registration after June 4th will be accepted based upon camp availability.
Payment must be made in full at time of registration.
Residents Non-Resident Fee
Regular (9 a.m. - 3 p.m.) $ 1,325.00 per child $ 1,535.00 per child
Morning Care (7 a.m. - 3 p.m.) $ 1,550.00 per child $ 1,760.00 per child
After Care (9 a.m. - 6 p.m.) $ 1,625.00 per child $ 1,835.00 per child
Full (7 a.m. - 6 p.m.) $ 1,800.00 per child $ 2,010.00 per child2021 SUMMER CAMP REGISTRATION
** All camp information, including trip sign-up notification and weekly camp updates, will be emailed.
Parents may also pick up weekly information at the Rec Office. No information will be sent home
with the campers. Please update your spam filters to allow email from FTREC@twp.freehold.nj.us.**
All forms must be completed in order for this application to be processed: Camper medical form,
pick up authorization form, code of conduct signed by participant and parent,
a copy of the birth certificate for first time participants.
PLEASE PRINT ALL INFORMATION CLEARLY
CHILD’S LAST NAME:___________________CHILD’S FIRST NAME:___________________
HOME ADDRESS_______________________________________________________________
TOWN/ZIP_____________________________________________________________________
HOME PHONE__________________________ WORK PHONE_________________________
CELL PHONE_____________________ EMAIL REQUIRED __________________________
(MANDATORY)
SEX : M F AGE:________ DOB: _____/_____/_____
GRADE IN SEPT. 2021:________ SCHOOL IN SEPT. 2021:_____________________
SHIRT SIZE: ADULT S M L XL CHILD S(6-8) M(10-12) L(14-16)
REGISTRATION FEE
Paid in Full By 3/30/21 Paid in Full By 5/20/21 Paid in Full By 6/4/21
CIRCLE PROGRAM AND FEE
Resident Non-Resident Resident Non-Resident Resident Non-Resident
Regular Hours (9:00 a.m.—3:00 p.m.) $980 $1,190 $1,165 $1,375 $1,325 $1,535
Morning Care (7:00 a.m.—3:00 p.m.) $1,205 $1,415 $1,390 $1,600 $1,550 $1,760
After Care (9:00 a.m.—6:00 p.m.) $1,280 $1,490 $1,465 $1,675 $1,625 $1,835
Full Day (7:00 a.m.—6:00 p.m.) $1,455 $1,665 $1,640 $1,850 $1,800 $2,010
Total Program Amount—Payment must be made in Full at time of registration. $
REMINDER * *$100.00 of each registration is NON-REFUNDABLE**
Optional Extended Week—August 16th—20th; 8:30 a.m.—5:30 p.m. add $205.00 $
Total Amount Due $
REGISTER ONLINE AT WWW.FREEHOLDTOWNSHIPREC.COM
Cash Check #_________ CC Authorization # _______________Staff ______
I understand that my child is participating at his/her own risk. I further understand that the Township of Freehold and Board of Parks and Recreation
Commission will be establishing health protocols and my child and I are participating at our own risk. I will abide by any health protocols established by the
Freehold Township Parks and Recreation Commission or the Director. I agree to hold the Township of Freehold, Recreation Commission or authorized
agents harmless for any injury or illness that may occur as a result of my child participating. I also acknowledge that my child may be photographed during
the program and that Freehold Township reserves the right to utilize all photos and videos taken during any recreation program.
______________________________________________________________________________
(SIGNATURE OF PARENT OR GUARDIAN) (DATE)
_________________________________________________________________________
(PLEASE PRINT FULL NAME)FREEHOLD TOWNSHIP PARKS & RECREATION
CAMPER MEDICAL FORM
Parent’s may complete this form. A doctor’s visit is not required.
Child’s Last Name:_____________________ Child’s First Name: ______________________Grade:___________
(Sept. 2021)
Please print all information. In case of emergency please notify:
(Anyone on the Emergency Contact List is automatically included on the pick up list.)
Parent/Guardian Contact information:
Parent/Guardian #1 _________________________________ Emergency Contact #: _______________________
Parent/Guardian #2 _________________________________ Emergency Contact #: ______________________
Additional Contact Person (in the event parent/guardian cannot be reached):
Name:_______________________ Emergency Contact #: __________________ Relationship: ______________
Doctor’s Name: ______________________________________ Phone #: ______________________
Restrictions if any: __________________________________________________________________
Will your child be taking medicine at camp? YES ______ NO _______
If yes, name of medication: ___________________________________________________________
HISTORY OF PAST/PRESENT DISEASE:
YES NO YEAR YES NO YEAR
___ ___ SERIOUS ILLNESS _____ ___ ___ HEART _____
___ ___ SERIOUS INJURY _____ ___ ___ STOMACH/BOWEL _____
___ ___ DEFORMITY _____ ___ ___ APPENDICITIS _____
___ ___ SURGERY _____ ___ ___ KIDNEY/BLADDER _____
___ ___ SKIN/GLANDS _____ ___ ___ INFECTION _____
___ ___ EARS _____ ___ ___ MENSTRUAL PROB._____
___ ___ EYES _____ ___ ___ HERNIA RUPTURE _____
___ ___ NOSE/SINUS _____ ___ ___ BACK/LIMB/JOINTS_____
___ ___ TEETH _____ ___ ___ BEHAVORIAL _____
___ ___ THROAT/TONSILS _____ CONDITION
___ ___ CHEST/LUNGS _____
___ ___ ALLERGIES (SPECIFY) ____________________________________________
___ ___ OTHER (SPECIFY) ________________________________________________
AUTHORIZATION
To the best of my knowledge, the Medical History is complete and accurate. I know of no reason to restrict applicant’s
activity, and give my permission for participation in all activities except as specifically noted herein. In the event that I
cannot be reached in an EMERGENCY, I hereby give permission to the physician selected by the camp director to
hospitalize, secure proper treatment for, and to order injections, anesthesia or surgery for person as named above.
I have read and understand the policies and procedures of Freehold Township Recreation’s Summer Camp.
______________________________________________ _________________________
Parent/Guardian Signature DateSUMMER CAMP
PICK UP AUTHORIZATION FORM
REQUIRED FOR EACH CAMP PARTICIPANT
GOVERNMENT ISSUED PHOTO ID IS REQUIRED!
Child’s Name:
Address:
Grade Sept. 2021: School Sept. 2021:
In addition to the 3 names listed as emergency contacts,
a maximum of 5 ADDITIONALS NAMES (must be 18 year s of age)
may be authorized to pick up your child from the Freehold Township Summer Camp.
NO CHANGES MAY BE MADE TO THE PICKUP LIST AFTER JUNE 8TH.
Government issued photo identification will be required at sign out.
Authorized Person’s Name Relationship to Child Phone Number
(please print name CLEARLY
as it appears
on photo identification)
Name of person(s) NOT allowed to pick up child (appropriate custody papers
must be attached if a parent is not allowed to pick up their own child).
Person’s Name Relationship to Child Phone Number
Parent/Guardian Signature: ____________________________Date:_________
Parent/Guardian Name Printed: ______________________________________Freehold Township’s Code of Conduct is for the wellbeing and safety of all program participants.
This condensed version is an outline of the full ordinance which can be obtained at www.twp.freehold.nj.us.
Freehold Township’s Code of Conduct must be signed and submitted
with all Parks and Recreation registration forms.
CODE OF CONDUCT
The participants, parents or legal guardians of minor participants, coaches and officials of every sports organization shall be required
to follow the Code of Conduct, set forth as follows:
I hereby pledge to be responsible for my words and actions while attending, coaching or participating in a Township sports event and shall con-
form my behavior to the following code of conduct:
1. I will not engage in unsportsmanlike conduct with any coach, parent, player, participant, official or any other attendee.
2. I will not encourage my child, or any other person, to engage in unsportsmanlike conduct with any coach, parent, player, participant,
official or any other attendee.
3. I will not engage in any behavior which would endanger the health, safety or well-being of any coach, parent, player, participant,
official or any other attendee.
4. I will not encourage my child, or any other person, to engage in any behavior which would endanger the health, safety or well-being
of any coach, parent, player, participant, official or any other attendee.
5. I will not use drugs or alcohol while at a youth sports event and will not attend, coach, officiate or participate in a youth sports event
while under the influence of drugs or alcohol.
6. I will not permit my child, or encourage any other person, to use drugs or alcohol at a youth sports event and will not permit my child,
or encourage any other person, to attend, coach, officiate or participate in a youth sports event while under the influence of drugs or
alcohol.
7. I will not engage in the use of profanity.
8. I will not encourage my child, or any other person, to engage in the use of profanity.
9. I will treat any coach, parent, player, participant, official or any other attendee with respect regardless of race, creed, color, national
origin, sex, sexual orientation or ability.
10. I will encourage my child to treat any coach, parent, player, participant, official or any other attendee with respect regardless of race,
creed, color, national origin, sex, sexual orientation or ability.
11. I will not engage in verbal or physical threats or abuse aimed at any coach, parent, player, participant, official or any other attendee.
12. I will not encourage my child, or any other person, to engage in verbal or physical threats or abuse aimed at any coach, parent, player,
participant, official or any other attendee.
13. I will not initiate a fight or scuffle with any coach, parent, player, participant, official of any other attendee.
14. I will not encourage my child, or any other person, to initiate a fight or scuffle with any coach, parent, player, participant, official or
any other attendee.
15. I will abide by any decision rendered by the Code of Conduct Committee or the Township Parks and Recreation Commission.
16. I will be responsible for the behavior of all those attending a Township youth sports event on my child’s behalf.
____________________________________________ _________________
Participants Signature Date
____________________________________________ _________________
Parent or Guardian Signature if participant is under 18 Date
**If participant is under 18 both signatures are required when submitting form.
No registration will be processed without properly completed forms.Freehold Township Parks & Recreation
2021 Summer Camp Health
Protocols & Program Agreement
All facilities including playgrounds and Splash Pads will be open. Playgrounds and
pavilion areas will be disinfected each morning before the regular camp day begins.
All staff and campers will have their temperatures taken each morning. Each group will
have a thermometer which will be turned in and disinfected daily. Staff will have their temps
taken and recorded by an Admin upon reporting to work. Campers will have their temps
taken and recorded by the Head or Senior Counselor during roll call. Any staff/camper who
has a fever of 100.4 or higher will not be permitted to stay at camp.
Each group will be assigned to a specific pavilion which will not be shared with other
groups. Tables will be disinfected before and after camp daily with an electrostatic
backpack sprayer.
Each group will be supplied with hand sanitizer that will be available to campers and staff
throughout the day. The Senior Counselor will squirt each child’s hands before lunch and
after lunch cleanup. In addition to soap and water being available in the bathrooms, hand
sanitizers will be located outside of the bathroom entry ways.
Individual groups will be supplied with individual group equipment bags so that there is no
cross contamination between groups. Equipment used by a group will not be shared with
another group until it has been disinfected. Two examples:
15 balls are used by 5th grade to play 4 square. 3rd grade arrives to play and will
play with their own 15 four square balls.
Following weekly group schedules becomes essential. If 4th grade plays Giant Connect
4, no group can use Giant Connect 4 in the next time slot. Equipment must be
disinfected before being put back in to use.
Staff and campers will be supplied with cloth face coverings which must be worn
upon arriving at camp through attendance. Face coverings are to be worn when
feasible.
Equipment sheds and refrigeration shed will be disinfected daily with
electrostatic sprayers/disinfectant.
Park vending machines will be available for groups at pre designated times throughout
the day.
No transportation to and from camp. No group trips for the 2021 season.
No camp‐wide events, i.e., Talent Show or any event that brings all campers together at the same
time. The Freedom Fest, Color Run and Olympic Day will be run in individual groups without an
opening ceremony. In the event of severe inclement weather, camp will be held at the Senior Center.
Parents will be notified of pending bad weather/thunder storms via a Rec Alert the
night before a projected storm. Parents will be responsible for dropping off/picking
up their child at the Senior Center, 116 Jackson Mills Road. Campers should bring
their lunch, snacks, and a water bottle. They should not bring a bathing suit/towel.
Current and/or additional protocols determined by the NJ Dept of Health will be
amended as mandated.
Updated Program Agreement
I understand that my child is participating at his/her own risk. I further understand
that the Township of Freehold and Board of Parks and Recreation Commission will
be establishing health protocols and my child and I are participating at our own risk. I
will abide by any health protocols established by the Freehold Township Parks and
Recreation Commission or the Director. I agree to hold the Township of Freehold,
Recreation Commission or authorized agents harmless for any injury or illness that
may occur as a result of my child participating. I also acknowledge that my child may
be photographed during the program and that Freehold Township reserves the right
to utilize all photos and videos taken during any recreation program.
I have received a copy of the Freehold Township Recreation Camp Health
Protocols and understand the information provided.
I have received a copy and agree with the updated Program Agreement.
Today’s Date: /
Camper’s Name (print clearly):
Parent/Guardian Signature:
Form MUST be fill out for EACH participant attending the 2021 summer camp program.
f you have any questions, please contact the Freehold Township Recreation office at
732-294-2190.You can also read
