POOL OPENS MEMORIAL DAY WEEKEND 2018 Featuring New Pool Building!

Township of Springfield

Summer 2018

Community Pool, Pool Day Camp, Swim Team, & Chisholm Playground Camp Raymond Chisholm Community Center

(973) 912-2227 phone • (973) 912-8584 fax www.springfield-nj.us/recreation www.facebook.com/springfieldnjrec www.facebook.com/springfieldcommunitypool [email protected] Monday-Friday, from 8:00 am-6:00 pm Cash, checks, and money orders payable to: Township of Springfield SAVE TIME…REGISTER ONLINE WITH A CREDIT CARD! https://register.communitypass.net/springfield $3 convenience fee per transaction is charged when using a credit card. All new pool members are required to get an identification picture taken at the Recreation Department or at the Community Pool. You must register first at the Recreation Department or online before your picture is taken. Membership registrations are not accepted at the Community Pool. The Springfield Community Pool is an accessible facility. SPRINGFIELD COMMUNITY POOL

Pool Opens Memorial Day Weekend! May 26, 27, & 28

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Welcome Pool Members and Guests On behalf of the Township of Springfield and the Springfield Recreation Department, I am excited to welcome everyone to summer 2018 at the Springfield Community Pool – featuring our newly reconstructed and enlarged pool building! The approximately 8,900-square foot state-of-the-art building will house new locker rooms and bathrooms, new fitness room, new dividable multi-purpose room available for party rentals, new kitchen and concession stand with covered seating pavilion, new covered drop-off portico, central breezeway with natural light, expanded storage, and new offices. Half of the building will be open year-round for party rentals and Recreation Department programs. This summer, we are also offering our popular day camp, freshly-painted main pool and baby pool, five large shade structures, water slide, diving board, children’s playground, basketball, sand volleyball, shuffleboard, bocce, tetherball, horse shoes, street hockey, group and private swim lessons, complimentary WiFi, and more! An exciting calendar of holiday programs, arts and crafts, water exercise classes, tournaments, contests, float nights, bingo, live music, and socials is planned by our activities director. Join us for a free preview of the new building and pool grounds on Friday, May 25th, from 4:00-7:00 pm. I look forward to seeing you this summer! Adam Lieb, Director of Recreation

Please read through the following: 3 4 5 6 7 8 9 10 11 12 13 14

Registration Procedures Membership Information Membership Application Pool Rules Pool Day Camp Introduction Pool Day Camp Categories & Fees Pool Day Camp Application Pool Day Camp Trips Swim Lessons Swim Team Chisholm Playground Camp Summer 2017 Memories 2

Springfield Community Pool Registration Procedures Online registration with a credit card is available at:

https://register.communitypass.net/springfield

$3 convenience fee per transaction is charged when using a credit card.

If registering in-person, please bring the following to the Recreation Department at the Chisholm Community Center: • Completed 2018 Application Form. • 2014-2017 Pool Photo ID (returning members) • Credit card, cash, check, or money order. Make payable to Township of Springfield. • $3 convenience fee per transaction is charged when using a credit card. • Proof of residency (new members): valid driver’s license or voter registration card. If registering by mail, please send the following: • Completed 2018 Application Form. • Copy of 2014-2017 Pool Photo ID (returning members) • Check or money order. Make payable to Township of Springfield. • Proof of residency (new members): copy of valid driver’s license or voter registration card. Before sitting for a Photo ID, all new applicants must first register, submit payment, and produce the proper proof of residency required for the desired membership category. Returning members who cannot produce a 2014-2017 Pool Photo ID will be charged $10 for a new card. MEMBERS WILL NOT BE PERMITTED INTO THE POOL WITHOUT POOL PHOTO ID. NO EXCEPTIONS! PLEASE RETAIN YOUR POOL PHOTO ID FOR 2019.

REGISTER IN-PERSON OR BY MAIL AT:

Office Hours: Monday-Friday, 8:00 am - 6:00 pm

2018 COMMUNITY POOL DATES AND HOURS: Pre-Season Weekends • 12:00-6:00 pm May 26th - June 17th Weekends • 11:00 am-8:00 pm June 23rd - September 2nd Weekdays • 12:00-8:00 pm June 25th - August 31st Holidays • 9:00 am-Close (time varies) May 28th; July 4th; September 3rd

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Pool Membership Information 2018 MEMBERSHIP CATEGORIES: •FAMILY – parents and all unmarried children ages 4 and older and including the age of 22, who reside within the same household. FAMILY+CAREGIVER – Same as Family category, but includes a caregiver. A caregiver refers to one person who is 16 years or older who is employed as a child, elderly, or healthcare worker. The caregiver must provide proof of age, as well as verification of employment signed by both the employer and caregiver. The caregiver is only permitted access to the pool while accompanying the member receiving the care. JOINT – Available to any two [2] persons residing in the same household. One member must be an adult. Two adults may join as Joint members only if all of your children residing in the household are under the age of 4. Two adults may not join as Joint members if you have at least one child age 4 or older. In that situation, you must join as a Family. INDIVIDUAL – One person between the ages of 13 and 61. SENIOR CITIZEN – Anyone who is 62 years or older. Proof of age is required for new members.

2018 POOL MEMBERSHIP AND GUEST RATES FULL MEMBERSHIPS FAMILY FAMILY+CAREGIVER JOINT INDIVIDUAL SENIOR INDIVIDUAL SENIOR COUPLE

Residents $349 $406 $282 $220 $ 90 $165

Non-Residents $527 $620 $458 $381 $215 $334

WEEKEND/HOLIDAY MEMBERSHIPS

Residents Only. Saturdays, Sundays, & Holidays Only. $178 $193 $126 $94 $50 $85 DAILY GUEST PASSES: Fee charged for individuals age 4 and older. Children age 12 & under must be accompanied by an adult. Cash only. Guests must provide photo ID listing address. Non-residents may only purchase guest passes when accompanied by a member. FAMILY FAMILY+CAREGIVER JOINT INDIVIDUAL SENIOR INDIVIDUAL SENIOR COUPLE

1 Day 2 Day Consecutive 3 Day Consecutive Senior Citizen [62 and older] Twilight [enter after 5:00 pm]

Residents $11 $18 $25 $7 $6

NO REFUNDS OR EXCHANGES ON MEMBERSHIPS OR PASSES ONCE PURCHASED.

Non-Residents Accompanied by a Member $16 N/A N/A $13 $ 8

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2018 Membership Application (In-Person/Mail)

Membership Residency (check one) Resident ____ Non-Resident ___ Membership Category Desired ________________________________ Last Name Street Address Town

Zip

Email Home Phone Cell Phone

First and Last Name

Date of Birth

Photo ID #

ADULT ADULT CHILD CHILD CHILD CHILD CAREGIVER

NO REFUNDS! NO EXCEPTIONS! Signature_______________________________________Date________

Make all checks and money orders payable to: Township of Springfield Register at the Chisholm Community Center, Online, or by Mail

ONLINE REGISTRATION WITH A CREDIT CARD https://register.communitypass.net/springfield $3 convenience fee per transaction is charged when using a credit card.

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2018 Pool Rules • Parents MUST supervise children in and out of the water at ALL TIMES. • All vehicles using the parking lot must park front end in only. • All vehicles must park only in spaces and areas designated by pool management. • Vehicles may not exceed a speed over ten [10] miles per hour. • Vehicles must move only in the one-way designated direction. • Dressing and undressing will be done in the locker rooms only. • All food shall be served or consumed within the concession area only. No food or beverages are allowed in the pool area. • Children under the age of 13 are not permitted to enter the pool complex unless accompanied by a responsible adult pool member or guest. • Destruction or tampering with property, or providing false membership information, will result in suspension of privileges or revocation of membership. • The township, pool management, and pool employees will not be responsible for valuables brought into the pool complex. • Sneakers/shoes are not permitted to be worn within the pool apron. • Children under the age of three [3], as well as any child who is not toilet trained, must wear APPROVED swim diapers in addition to a bathing suit in either pool. These diapers are available for purchase at the front desk. • Diving is permitted in designated areas only. • No person is allowed in the pool unless a lifeguard is present. • No pets or animals. • No smoking inside the pool fence. • No alcoholic beverages. • No glass or glass containers are allowed in the pool complex. • Conduct or language that affects the comfort and safety of others is prohibited. • Floatation devices prohibited except at designated times. • Dress in and out of the pool shall be consistent with standards of good taste. • Water closes 15 minutes before the pool complex closes.

A complete set of rules is posted at the pool.

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2018 Springfield Pool Day Camp

Pool Day Camp – one of the highlights of summer in Springfield – is open to children entering Pre-K and/or age 4 by December 1, 2018, through age 13 and/or entering grade 8. Camp runs for eight weeks from Monday, June 25th, to Friday, August 17th. There is no camp on Wednesday, July 4th, in observance of Independence Day. Two extended weeks are available from Monday, August 20th, to Friday, August 31st. Camp hours are 8:30 am to 4:30 pm. Before-care and after-care is offered. Camp enrollment is limited and may become full during the registration period. Our qualified staff includes adult directors, in addition to experienced counselors who are high school and college students. Staff members have attended counselor training and orientations, and most are certified in First Aid/CPR/AED. Certified lifeguards are also available for medical assistance. Campers are divided into groups by age. Children will participate in age-appropriate activities including: swimming, sports and games, arts and crafts, music, cooperative play, and much more!. Each week is designated with a theme. Games, activities, and crafts projects will incorporate the weekly themes. In addition, a Color War competition will take place at some point during the summer. The exact week cannot be revealed because part of the fun is "breaking Color War" and the excitement building up to that point. HINT: Color War will not take place during the first or last weeks of camp. During Color War, camp is divided into five teams. Teams will compete in various games and activities, decorate banners, and create theme songs! Campers receive two t-shirts that must be worn every day. Additional t-shirts may be purchased for $8 each. Snack is included for campers enrolled in the full-day or afternoon sessions. Lunch may be brought from home or is available from the snack bar. Lunch tickets must be purchased in advance directly from the snack bar operator. If your child is registered for group swimming lessons or Swim Team, please advise the camp director and counselors. They will make arrangements for your child to get to those programs on time.

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Pool Day Camp Categories & Fees 8 Week Camps

June 25-August 17

CAMP A - FULL DAY

$1,047*

$1,348

CAMP B - MORNING

$615

$719

CAMP C - AFTERNOON

$615

$719

8:30 am-4:30 pm

8:30 am-12:30 pm 12:30 pm-4:30 pm

$1,338*

$1,749

*Springfield Residents: Save $100 on Camp A for each additional child registered.

2 Week Camps

Session 1: June 25 - July 6 (no camp July 4) Session 2: July 9 - 20 Session 3: July 23 - August 3 Session 4: August 6 -17

CAMP D - FULL DAY 8:30 am-4:30 pm

CAMP E - MORNING 8:30 am-12:30 pm

CAMP F - AFTERNOON 12:30 pm-4:30 pm

$365*

$464

$230

$297

$230

$297

*Springfield Residents: Save $25 on Camp D for each additional child registered.

Extended Weeks

Resident Non-Resident Pool Member or Camper Pool Member or Camper

CAMP J - FULL DAY August 20-24 • 8:30 am-4:30 pm

$193

$255

CAMP K - FULL DAY Aug. 27-Aug. 31 • 8:30 am-4:30 pm

$193

$255

Before/After Care

(Not Available Extended Weeks)

BEFORE CARE AFTER CARE

Two Week Session/Child

7:45 am-8:30 am

60

4:30 pm-5:30 pm

65

LATE PICK-UP POLICY

Campers must be pre-registered and pre-paid for Before or After Care. Regular camp hours begin at 8:30 am and end at 4:30 pm. Campers who are not pre-registered for Before Care will not be allowed inside the camp gates before 8:30 am and should not be left unattended outside camp gates. Parents of campers who are not registered for After Care and arrive for pick-up after 4:30 pm will be charged $5 for every 30 minutes late. Parents of any campers who arrive for pick-up after 5:30 pm will be charged $10 for every 15 minutes late.

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Pool Day Camp Application Form ONE CAMPER PER FORM

REGISTER BELOW OR ONLINE: https://register.communitypass.net/springfield $3 convenience fee per transaction is charged when using a credit card.

New campers are required to provide a copy of their birth certificate and proof of residency. No refunds.

Please circle the camp(s) you are registering your child.

Before Care June 25 - July 6 July 9 - 20

July 23 - August 3

August 6 -17

After Care

July 23 - August 3

August 6 -17

June 25 - July 6 July 9 - 20

First Name __________________________Last Name ________________________Date of Birth ___________ School (Fall 2018) _________________________________________Grade (Fall 2018) __________________ Street Address _____________________________________ Town ____________________ Zip Code _______ Home Phone _______________________ Parent Email ______________________________________________ Parent Name _______________________________Cell ____________________ Work Phone _____________ Parent Name _______________________________Cell ____________________ Work Phone _____________

Health Concerns, Allergies, Communicable Diseases, Epi-Pen, Inhaler, Glucagon, Medications, Accommodations Requested:

Month & Year of Immunization: MMR_____HIB_____DTHP_____Varivax______Polio______Other________ T-Shirt Size (circle)

YXS (4-5) YS (6-8)

YM (10-12)

YL (14-16)

YXL (18-20)

AS

AM

AL

AXL

# extra t-shirts @ $8 each ______________ Each camper receives two t-shirts that must be worn every day. On behalf of my child, I agree to indemnify, defend, and hold harmless the Township of Springfield, its elected and appointed officials, officers, employees, agents, and volunteers from any and all claims arising from our child’s participation in 2018 Pool Day Camp. Such indemnification shall include, but not be limited to, liability settlements, damage awards, costs, and attorney fees associated with any such claims. This indemnification will not include any acts that could be construed as intentional. I recognize that neither the Township of Springfield nor any of its officials, officers, employees, agents, or volunteers will be held responsible for any injuries or accidents sustained by my child during the course of his or her participation in 2018 Pool Day Camp, including, but not limited to, any injury resulting from an allergic reaction to anything to which he or she is exposed at 2018 Pool Day Camp. Permission is hereby granted for my child to engage in this program. I understand that the Chisholm Community Center and the Springfield Community Pool are open to the public, and members of the public and the press may advertently or inadvertently photograph and video my child and use those images for their own use without my permission. I give permission for my child’s photograph and video to be captured by Township of Springfield employees and used in print publications, online publications, presentations, websites, and/or social media. I give permission for my child to be transported by Township vehicle, Board of Education vehicle, or chartered vehicle to/from the Chisholm Community Center and the Springfield Community Pool, and for field trips. In order to meet all legal requirements, I hereby authorize representatives of the Springfield Recreation Department or Springfield Community Pool to give consent for any and all necessary emergency First Aid or medical care for my child while he or she attends this program.

Parent/Guardian Name (print) ____________________________________________ Signature ______________________________________________________________ Date _______________

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Pool Day Camp Trips

Pool Day Camp participants can attend up to six fun and exciting bus trips this summer! Registration for each trip is limited and is accepted on a first-come first-served basis. Once each trip is filled, we will maintain a wait list. Transportation is provided on Springfield Board of Education school buses or chartered buses. Trips are chaperoned by Pool Day Camp staff. Please bring a bag lunch and drink on all trips (unless noted otherwise below). No refunds are issued unless the spot is filled by another camper. Afternoon session campers may attend trips, but must be dropped off no earlier than 15 minutes prior to trip departure time. Morning session campers should be picked up from trips at the approximate return time. Thank you for your cooperation. ONE CAMPER PER FORM REGISTER BELOW OR ONLINE: https://register.communitypass.net/springfield $3 convenience fee per transaction is charged when using a credit card. Please check the trip(s) and submit cash or check payable to: TOWNSHIP OF SPRINGFIELD Friday, July 6th: Gravity Vault, Chatham, NJ

_______ $40

Wednesday, July 11th: Great Wolf Lodge, Scotrun, PA

_______ $59

Thursday, July 19th: Medieval Times, Lyndhurst, NJ

_______ $48

Friday, July 27th: Funplex & Splashplex, East Hanover, NJ

_______ $39

Wednesday, August 1st: Dave & Buster’s, Woodbridge, NJ

_______ $43

Tuesday, August 7th: YESTERcades, Westfield, NJ

_______ $22

This new trip includes 1 ½ hours of supervised rock climbing instruction, exciting indoor games, and lunch in the party room. The trip is limited to children ages 5+. Bus leaves at 9:30 am and returns at approximately 12:30 pm.

All-day pass to 79,000-square feet of water-packed excitement. Includes lunch of salad, pizza, breadsticks, cookies, brownies, and drinks. Bus leaves at 8:00 am and returns at approximately 5:00 pm. Live performance and a feast! Menu includes garlic bread, oven roasted chicken quarter, sweet-buttered corn, herb-roasted potato, chocolate chip cookie, and soda or water. (Vegetarian and Kosher available with advance notice. Kosher meal—market price). Bus leaves at 9:30 am and returns at approximately 2:30 pm. Indoor theme park, bowling, go-karts, rides, water slides, lazy river, and more! Unlimited activities plus a $5 fun card for the arcades. 2 pieces of pizza OR 2 hot dogs and a medium drink included. Bus leaves at 9:15 am and returns at approximately 2:30 pm. At this popular indoor entertainment center, campers will enjoy a lunch of pizza bites, crispy chicken bites, bar burgers, mac and cheese, French fries, and unlimited soda. Campers will also receive a $10 power card and unlimited video games. Bus leaves at 9:30 am and returns at approximately 4:30 pm. At this retro arcade’s brand new location, campers will have unlimited access to over 100 arcade games, pinball, air hockey, billiards, and a dance machine. Bus leaves at 10:00 am and returns at approximately 2:00 pm.

TOTAL $ __________

First Name __________________________Last Name___________________________________ Date of Birth __________________ Home Phone ____________________ Parent Email _____________________________________ Parent Name ____________________Cell Phone ___________Work Phone ____________ Parent Name ____________________Cell Phone ___________Work Phone ____________ Emergency Contact Names & Phones (List people who are available to pick-up your child up, if needed): 1)______________________________________________________________________ 2)______________________________________________________________________ On behalf of my child, I agree to indemnify, defend, and hold harmless the Township of Springfield, its elected and appointed officials, officers, employees, agents, and volunteers from any and all claims arising from our child’s participation in 2018 Pool Day Camp. Such indemnification shall include, but not be limited to, liability settlements, damage awards, costs, and attorney fees associated with any such claims. This indemnification will not include any acts that could be construed as intentional. I recognize that neither the Township of Springfield nor any of its officials, officers, employees, agents, or volunteers will be held responsible for any injuries or accidents sustained by my child during the course of his or her participation in 2018 Pool Day Camp, including, but not limited to, any injury resulting from an allergic reaction to anything to which he or she is exposed at 2018 Pool Day Camp. Permission is hereby granted for my child to engage in this program. I understand that the Chisholm Community Center and the Springfield Community Pool are open to the public, and members of the public and the press may advertently or inadvertently photograph and video my child and use those images for their own use without my permission. I give permission for my child’s photograph and video to be captured by Township of Springfield employees and used in print publications, online publications, presentations, websites, and/or social media. I give permission for my child to be transported by Township vehicle, Board of Education vehicle, or chartered vehicle to/from the Chisholm Community Center and the Springfield Community Pool, and for field trips. In order to meet all legal requirements, I hereby authorize representatives of the Springfield Recreation Department or Springfield Community Pool to give consent for any and all necessary emergency First Aid or medical care for my child while he or she attends this program.

Parent/Guardian Name (print) _____________________________________ Signature ____________________________________Date_______________

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2018 Swim Lessons

The Springfield Community Pool offers two 3-week sessions of group swim lessons. Lessons are taught on Monday, Tuesday, and Thursday of each week. Friday is reserved for rain make-ups. There are a total of nine lessons during each session. Each lesson is limited to approximately 10 swimmers. Swim lessons are open to pool members only. There are no refunds.

FEE PER 3-WEEK SESSION: $75 PER CHILD

Please circle a Session and a Class choice. Session 1: June 25 - July 13 9:00am-9:30am

Session 2: July 15 - August 3

Level 1

Level 2

Level 3

10:00am-10:30am Level 1

Level 2

Pre School Beginner

11:00am-11:30am Aqua Tots

Level 3

Pre School Beginner

CLASS DESCRIPTIONS

AQUA TOTS - Parent/guardian and child aquatic class. The parent/guardian accompanies the child into the pool. This class is designed for children 6 months to 3 years old, but is also open to children 3-5 years old who do not feel secure in the water without a parent/guardian. The focus of this class is water adjustment. Skills taught include: supported kicking, bubble blowing, front crawl arm movement, gliding, jumping in, and floating. Personal flotation devices are prohibited during lessons. PRE-SCHOOL BEGINNER - This is a beginning swim class appropriate for children 3-5 years old. This class is taught in the shallow water. The focus of this class is water adjustment and basic aquatic skills. Skills taught include: supported kick on stomach and back, back float, jumping in, going underwater to pick up submerged objects, and front crawl arm movement. Personal flotation devices are prohibited during lessons. LEVEL 1 - This is a traditional beginning swim class that focuses on water adjustment and stroke preparedness. Skills to be taught include: bobbing, floating on back, front glide, back glide, jumping into chest deep water, picking up submerged objects underwater, flutter kicking on front and back, and arm movement for front crawl. LEVEL 2 – Same as Level 1, but at a higher level of skill work. LEVEL 3 - This class focuses on stroke readiness. Skills taught are rhythmic breathing, front crawl with side breathing, back crawl, elementary backstroke kick, treading water, and diving from kneeling position. Pre-requisites: 1) Must be able to swim 5 yards unassisted; 2) Must be able to jump in deep water and swim to side; 3) Must be able to float on back unassisted; 4) Must be able to pick up an object submerged in chest deep water. PRIVATE LESSONS - Private lessons are offered at any time during pool hours, when an instructor is available. The cost is $85 per child for two 30-minute lessons. For information and to pay, please speak with a pool manager. Private lessons are open to pool members only. REGISTER BELOW OR ONLINE AT https://register.communitypass.net/springfield $3 convenience fee per transaction is charged when using a credit card. Or complete this page and return with payment to Springfield Recreation Department, Chisholm Community Center, 100 South Springfield Avenue. Checks/money orders payable to Township of Springfield.

First Name____________________________Last Name _________________________Date of Birth ____________ Address________________________________________________________________________________________ Home Phone _____________________Parent Cell Phone ____________________Parent Work Phone __________ Parent Email ____________________________________________________________________________________ My child has been examined by a physician and, to the best of my knowledge, is physically fit to participate in this swimming program. The Township of Springfield, officials, employees, agents, and volunteers will not be liable for any injury in connection with this program. Parent Name (print) _____________________________________________________ Parent Signature ___________________________________Date ________________

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Swim Team Informational Meeting Wednesday, May 23 @ 7:00pm at the Chisholm Community Center 100 South Springfield Avenue, Springfield, NJ 07081 REGISTER BELOW OR ONLINE AT https://register.communitypass.net/springfield $3 convenience fee per transaction is charged when using a credit card.

$80 Check Payable to: Township of Springfield

$20 Check Payable to: Swim Team Parent Association

The Springfield Swim Team is open to girls and boys from 5–17 years old. The Swim Team will be divided into two groups. The Developmental Team will be made up of children 8 years old and younger who need more instruction and guidance. Developmental Team participants initially must be able to demonstrate the ability to submerge themselves underwater, swim freestyle for at least 15 yards, be able to swim on their back, and be willing and able to swim in the 5 foot and 12 foot sections of the main pool. Children who do not meet these expectations – or who the coaches feel are unable to do so without support – will be placed in group Swim Lessons (see previous page) that are not affiliated with the Swim Team. The Swim Team Parent Association check will be returned to you in that circumstance. Coaches will assess these registrants during the first week of practice and will determine if a child is assigned to the Developmental Team or placed in Swim Lessons. All Swim Team registrants who are 9-17 years old do not need to try out. But in order to become a member of the Swim Team, participants must be able to swim a lap of the main pool without stopping and be comfortable swimming in deep water. Practices will begin after school starting Tuesday, June 5th, and in the mornings beginning Monday, June 25th. Swim meets (mostly evenings) run from Monday, June 25th, to Friday, July 27th Springfield residents are eligible to participate on the Springfield Swim Team without being a pool member. Non-residents who wish to participate must be a pool member.

2018 SPRINGFIELD SWIM TEAM REGISTRATION FORM (PLEASE PRINT) First Name _______________________________ Last Name __________________________________ Gender (circle)

Male

Female

Parent Email __________________________________________________________________________ Date of Birth ___________________School (Fall 2018) ______________Grade (Fall 2018) _______ Address _____________________________________________________________________________ Home Phone _________________ Parent Cell Phone ___________________ Parent Work Phone______________________Emergency Contact/Phone _____________________ Health Concerns, Allergies, Communicable Diseases, Epi-Pen, Inhaler, Glucagon, Medications, Accommodations Requested:

_______________________________________________________________________________________ ______________________________________________________________________________________ T-Shirt Size (circle)

YXS (4-5)

YS (6-8)

YM (10-12)

YL (14-16)

YXL (18-20)

AS

AM

AL

AXL

My child has been examined by a physician and, to the best of my knowledge, is physically fit to participate in the Springfield Swim Team. The Township of Springfield, officials, employees, agents, and volunteers will not be liable for any injury in connection with this program. I give permission for my child to ride on a Board of Education vehicle as transportation to/from swim meets. I understand that the Springfield Community Pool is open to the public, and members of the public and the press may advertently or inadvertently photograph and video my child and use those images for their own use without my permission. I give permission for my child’s photograph and video to be captured by Township of Springfield employees and used in print publications, online publications, presentations, websites, and/or social media.

Parent Name (print) __________________________________________________________________ Parent Signature _____________________________________________________________________ Date __________________________

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Chisholm Playground Camp

Chisholm Playground Camp is a morning program (8:30 am-12:30 pm) that operates outside at Chisholm Park and inside the Chisholm Community Center at 100 South Springfield Avenue. Camp is supervised by an adult director and counselors (high school-age and older). Activities include sports, games, arts and crafts, baking, theme days, Fridays at the Springfield Community Pool, one field trip, and much more! Camp is open to boys and girls ages 3 to 13, and is limited to the first 100 campers registered per week. Campers must be potty-trained. Snacks are included in the fee. Parents should provide children with a drink. Camp runs for eight individual weeks. You may register for any number of weeks. Registration deadline is Thursday prior to each camp week. New campers are required to provide a copy of their birth certificate and proof of residency.

REGISTER BELOW OR ONLINE: https://register.communitypass.net/springfield

$3 convenience fee per transaction is charged when using a credit card.

Resident first child: $55

FEES PER WEEK (NO REFUNDS): Resident additional child: $50 Non-Resident child: $65

Check applicable week(s)

Week #1: June 25-June 29 Week #2: July 2-July 6 (No camp July 4) Week #3: July 9-July 13 Week #4: July 16-July 20

Week #5: July 23-July 27 Week #6: July 30-August 3 Week #7: August 6 -August 10 Week #8: August 13-August 17

First Name ___________________ Last Name ________________Date of Birth _________ School (Fall 2018) _____________________Grade (Fall 2018) ______________________ Street Address _______________________________________________________________ Town _________________________________ Zip Code _____________________________ Home Phone ____________________ Parent Email _________________________________ Parent Name ____________________Cell Phone ____________Work Phone ____________ Parent Name ____________________Cell Phone ____________Work Phone ____________ Emergency Contact Names & Phones (List people who are available to pick-up your child up, if needed): 1)______________________________________________________________ 2)______________________________________________________________ Doctor’s Name & Phone: _________________________________________________ Health Concern, Allergies, Communicable Diseases, Epi-Pen, Inhaler, Glucagon, Medications, Accommodations Requested:

_______________________________________________________________

Month & Year of Immunization: MMR_______HIB_______DTHP_______Varivax______Polio___________Other__________ T-Shirt Size (circle) YXS (4-5) YS (6-8) YM (10-12) YL (14-16) YXL (18-20) AS

AM

AL

AXL

# extra t-shirts @ $8 each ______________ Each camper receives one t-shirt that must be worn every day. On behalf of my child, I agree to indemnify, defend, and hold harmless the Township of Springfield, its elected and appointed officials, officers, employees, agents, and volunteers from any and all claims arising from our child’s participation in 2018 Chisholm Playground Camp. Such indemnification shall include, but not be limited to, liability settlements, damage awards, costs, and attorney fees associated with any such claims. This indemnification will not include any acts that could be construed as intentional. I recognize that neither the Township of Springfield nor any of its officials, officers, employees, agents, or volunteers will be held responsible for any injuries or accidents sustained by my child during the course of his or her participation in 2018 Chisholm Playground Camp, including, but not limited to, any injury resulting from an allergic reaction to anything to which he or she is exposed at 2018 Chisholm Playground Camp. Permission is hereby granted for my child to engage in this program. I understand that the Chisholm Community Center and the Springfield Community Pool are open to the public, and members of the public and the press may advertently or inadvertently photograph and video my child and use those images for their own use without my permission. I give permission for my child’s photograph and video to be captured by Township of Springfield employees and used in print publications, online publications, presentations, websites, and/or social media. I give permission for my child to be transported by Township vehicle, Board of Education vehicle, or chartered vehicle to the Springfield Community Pool and for field trips. In order to meet all legal requirements, I hereby authorize representatives of the Springfield Recreation Department or Springfield Community Pool to give consent for any and all necessary emergency First Aid or medical care for my child while he or she attends this program.

Parent/Guardian Name (print) _____________________________________________ Signature _____________________________________ Date___________________________________

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Summer 2017 Memories! Summer at the Springfield Community Pool is filled with fun and exciting activities for members and guests of all ages! Fathers Day Diving Contest

Daily Water Aerobic Classes

Pie for a Cause

Sugar Cookie Day First Responder Day

Eclipse Viewing Party

Float Night

Teddy Bear Picnic Honey Bee Awareness Day

Senior Citizen Breakfast

Independence Day

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Springfield Recreation Department Chisholm Community Center 100 South Springfield Avenue Springfield, NJ 07081

Free Frida Preview N y, M igh 4:00 ay 25, 20 t -7:00 18 p m NEW POOL BUILDING

FEATURES 8,900 SQ. FT. OF SPACE! • • • • • • • • •

New locker rooms, bathrooms, and changing areas Fitness center with state-of-the art equipment Dividable multi-purpose room for camps, parties, classes, meetings, and events New kitchen and concession stand with shaded seating pavilion Covered entry portico for drop-off and pick-up Central breezeway with natural light New offices for front gate, managers, first aid, lifeguards, and camps Covered gathering space with built-in seating Expanded storage areas

Recreation Department (973) 912-2227 • Community Pool (973) 912-0039 www.springfield-nj.us/recreation • www.facebook.com/springfieldnjrec www.facebook.com/springfieldcommunitypool • [email protected]