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Stevens Park Summer Recreation Program Registration Form


    June 26th – August 4th 9:30 am – 3:30 pm
    For Elementary School Age Children (entering Kindergarten to 5th Grade)
    The rate for the Summer Program is a flat fee of $110 per child and $90 for additional siblings if you live in the following zip codes, 20837, 20838, 20839, 20841, 20842. For children out of those zip codes the rate is $275. You can pay the fee in person at Town Hall via check or credit card, by mail or on the first day of camp.   

     For the PDF version of this form Click Here.

  2. Please specify the allergies that your child has.
  3. In case of emergency, notify:
  4. Release of Liability / Photo Release
    By clicking agree, I the parent or legal guardian of the above named child, I certify that said child has my permission to attend and participate in the Poolesville Summer Recreation Program. In signing this form, I hereby waive and release all other participants, the host, sponsors, and all other officials or parties involved in the recreation program. I also hereby grant the authorities the unconditional right to use the name, voice, and photographic likeness of the above named child in connection with any of their articles or press releases, but not as endorsement.

    I understand that said child is enrolled for instruction and experience in sports, games, and crafts and is expected to be a participant in the planned activities. It is further understood that any child who excuses him or herself from the activities is expected to “sit - out” completely for the duration of the session. Parents are responsible for any damage done by the youngsters absenting themselves from the activities.
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