Cohasset Recreation
2015 Summer
Playground
Application Packet
Registration Begins at the
Health & Rec Fair
Sunday, March 22 ~1 pm
Cohasset Recreation
2015 Summer Playground
Welcome to our 48th Year
What you need:
 Complete Application (all information on both sides printed clearly)
 Full Payment by check or completed credit card authorization form.
 Account set-up and in good standing at www.cohassetrec.com (no balances).
 Recent Photo attached with application.
 Most recent copy of your child’s immunization records.
Coming to the Fair:
 Please do not arrive before 1 p.m. to allow vendors time to set-up.
 Please park in designated parking spots (no parking on the grass/snow), please
utilize the Osgood parking spaces.
 Please consider carpooling or walking to our event.
 Please spend time at our Fair and visit all our vendors, we have a lot of great
new programs and vendors this year.
 Did you know the Board of Health component of the fair has over 30 vendors
with free health screenings? Head to the cafeteria to check them out.
2015 Summer Playground Program
A town tradition celebrating its 48th year
Registration: Sunday, March 22nd (at the Health and Rec Fair)
Registration Closes when enrollment is reached.
Where
Joseph Osgood and Deer Hill School
When
th
Monday, June 29 through Friday, August 14th
No program Friday, July 3rd
Pre-School Program
½ day Program - 9:00 a.m. to Noon
Ages: 3 ½ to 5 ½ (going into Kindergarten)
Children must be toilet trained.
Limited Enrollment – Cohasset Residents only
Half-Day High 5 Program
Extended ½ day Program - 9:00 a.m. to 1:00 p.m.
Age: 5 by April 1st (for those too old for pre-school and full day is too long)
Limited Enrollment – Cohasset Residents only
Playground Program
Full day Program - 9:00 a.m. to 3:00 p.m.
Ages: 5 ½ to 12 years (completed kindergarten)
Program Fees
$482
$512
$532
Pre-School Program
Half-Day High 5 Program
Playground Program
Non-Resident Playground Program (only)
$732
st
Non- resident registration begins April 1 – space permitting
RISE
RISE is our before and after care for our Summer Program at the Deer Hill
7:00 a.m. to 9:00 a.m. All Age Groups
3:00 p.m. to 6:00 p.m. Full-Day Program only
Financial Assistance: Consideration upon written request no later than April 1st.
Refunds: All refund requests must be in writing (email Ted at: [email protected])
If you withdraw before April 1, a refund for the program fee will incur a $30 processing fee per child. Refund requests after April 1st
and before June 1st will receive a refund minus a $60 processing fee per child. No refunds will be given after June 1 st.
Cohasset Summer Program Early Notes
Once registered for the Cohasset Recreation Summer Programs all parents will receive a Parent Packet via email
April 27th, however, in order to communicate efficiently we have put together some helpful notes.
Application Process - You may pay by check or credit card, however, we must have the following to
complete your registration. Remember space is limited so don’t delay. Your application is not complete
and not considered a participant in the program until we have the following:
 Hard Copy of Application – Registration is not complete without original application.
 Payment
 Family Account set up at www.cohassetrec.com and no previous balances due.
 Current Photo of Child
 Copy of Immunization Records
 Signed Consent for Treatment for Allergic Reaction (if required) - Due by June 1st
Cohasset Recreation Extras - Swim Lesson Registration & Payments, Music Circus Registration &
Payments, Pizza Card Registration & Payments, and Permission Slips for field trips may be done online
or in the office between May 1st and May 30th or until space permits.
 Swim Lessons – Cohasset Recreation has a designated half-hour for swim lessons, where our
staff walks children to and from lessons. Registration is done through cohassetrec.com (Do not
register with the Swim Center). The recreation half hour is at 11:30 a.m. for all levels. Pre-School
children who register will need to be picked up at the Swim Center at noon. Members of the
Swim Center pay $65 Per Session and Non-Members pay $85.00. Proof of pool membership
required. – Space is limited – Registration begins May 1st
 Music Circus – Regular Playground Program activities will continue for those who do not
attend. The shows are 7/16 – Snow White, 7/30 – Pinocchio, 8/6 – Goldilocks and the Three
Bears. All shows are $11.00 per show. You may do so online.
 Pizza Card – We offer pizza to the kids on Wednesdays (July 1-August 12). The fee is $5.00 a
week and you can either purchase an entire summer for $30.00 or individual days online at
cohassetrec.com. Pizza must be ordered by June 1st.
 Field Trips –Field Trips are optional, however, there will be no program for those who do not
attend as all staff are needed. The Field trips are 7/10 – Carousel Family Fun Center, 7/31 Boston
Bowl (Ages 5-12). Permission Slip and $10 per trip will also be required.
 RISE – Before and After Care Registration begins online May 1st at www.cohassetrec.com
Drop-Off and Pick-up Policy
 Playground drop-off will be from 8:50 to 9:05 a.m. and pick-up will be from 2:50 – 3:05 p.m.
 Pre-School drop-off will be from 8:50 to 9:05 a.m. and pick-up will be from 11:50 -12:05 p.m.
 Half Day 5’s drop-off will be from 8:50 to 9:05 a.m. and pick-up will be from 12:50 – 1:05 p.m.
 We have a late fee of $1 per minute per child beginning at 12:06 p.m. (preschool), 1:06 p.m. (Half
Day 5’s) and 3:06 p.m. (playground). The fee must be paid before the child returns.
 Drop-off and Pick-up is LIVE in front of the school and if you need to get out and speak with
someone please park in the parking lot and not the Fire Lane and make sure to sign in/out with
a counselor or Kate in the cafeteria.
Cohasset Recreation Department
Office Use Only
Immunization Records: _____
Photo:
_____
Payment form:
_____
2015 Summer Playground Program
Recent photo required
Registration Form
Circle Program
(Pre-school Program for ages 3 ½-5)
(Half-day High 5 year old program)
(Playground Program for ages 5 ½ -12)
_________________________________________________________________________________________________________
Child’s Last Name:
Child’s First Name:
(Nickname, if any)
Sex: Male / Female
Age:
DOB:
Grade Now:
Email: __________________________________ T-Shirt Size: Circle YXS / YS / YM / YL / AS / AM / AL
Best Cell Phone # for Text Message Alerts: ______________________Cell Phone Carrier ___________
Parent Name: _____________________________
Phone (H)
(C)
Address: ________________________________
Work #:_________________Schedule_____________
_______________________________ Email:
Parent Name: _____________________________ Phone (H)
(C)
Address: ________________________________
Work #:_________________Schedule____________
_______________________________ Email:
Guardian is: _________
(If foster child, name of social worker)
Please notify us in writing of any special custody situations
Agency Name & Number:
Brothers & Sisters (ages) In Program:
Not in Program:
Emergency Contacts (other than parents):
1.
Phone: (H)
Address:
2.
Phone: (H)
Address:
Relationship:
(C)
Relationship:
(C)
My child may be released to (other than the above): _______________________________________________
__________________________________________________________________________________
Please list any special information that you think will be helpful for your child's counselor to know about
your child (Special interests, hobbies, likes, dislikes, etc.)
____________________________________________________________________________________
CONTINUED
Medical Information:
Immunizations are required- please attach a copy
Allergies (Include RX):
Please list any and all medications taken: School year & Summer
Special Medical Information:
Insurance Company:
Family Doctor:
Policy Number:
Phone Number:
Any other special info/needs we should be aware of:
Summer Schedule:
Monday
Tuesday
Wednesday
Thursday
Friday
June 29
June 30
July 1
July 2
July 3
______________________________________________________No Program
July 6
July 7
July 8
July 9
July 10
_________________________________________________________________
July 13
July 14
July 15
July 16
July 17
_________________________________________________________________
July 20
July 21
July 22
July 23
July 24
_________________________________________________________________
July 27
July 28
July 29
July 30
July 31
___________________________________________________ _____________
Aug.3
Aug.4
Aug.5
Aug.6
Aug.7
_______
Aug.10
Aug.11
Aug.12
Aug.13
Aug.14
_________________________________________________________________
Attendance Policy: Please notify the office on days your child(ren) will not be in attendance via phone or email by 8 AM
__________________________________________
The Cohasset Recreation Department assumes responsibility for children during designated hours of the program.
Parents are responsible for providing transportation to and from the program at the proper times.
Late fees will be incurred for children not picked up at the scheduled end of the program.
RELEASE: I understand the activities of this program, its rules and requirements and its potential risks. I accept these
conditions and hereby grant permission for my child’s participation. I hereby forever release the Town of Cohasset, Cohasset
Recreation & School Department and it officers, employees, agents and volunteers from any and all claims for damages with
respect to or in connection with all known and unknown personal injuries incurred by my child while participating in the
program or event except for damages caused solely by the negligence of the Town of Cohasset, Cohasset Recreation & School
Department or its officers, employees, agents or volunteers. I hereby agree to indemnify and hold harmless the Town of
Cohasset, Cohasset Recreation & School Department and its officers, employees, agents and volunteers with respect to any
such claims for damages which are not caused solely by the negligence of the Town of Cohasset, Cohasset Recreation &
School Department, or its officers, employees, agents or volunteers. Photos are periodically taken of participants in a
program, class, during special events, or at the Recreation Center. Please be aware that these photos are for the Recreation
Department’s use only and may be used in the Recreation Department’s brochures, calendar, pamphlets or flyers.
PERMISSION IS GRANTED FOR ANY EMERGENCY MEDICAL TREATMENT NEEDED.
Date:
Signature of parent or guardian:
Please notify the Recreation Office if there are any changes in the above data.
Town of Cohasset
Credit Card Authorization
Please Print Clearly
Family Name
______________________________
Email Address
______________________________
Payment for
Child _________ Amount _______ Child _________ Amount _______
Child _________ Amount _______ Child _________ Amount _______
Voluntary Donation to the Jack Worley Staff Scholarship Fund $__________
Total
thank you
______________________________
Payment Information
Credit Card Master Card
Visa
Credit Card Number ________ - __________ - _________ - _________
Expiration Date _______/________
Security Code (3 digits on the back of the card) ____________
Card Holders Name: ___________________________________
Credit Card Address:
I authorize Cohasset Recreation to charge my credit card for the following amount:
$ ________________
I understand the application will not be processed without a photo and immunization record.
Authorized Signature:
___________________________________________Date____________________
Please Note: registration for the Playground program extras, including swim lessons, field trips, pizza days,
free swim and Music Circus begins May 1st and will close June 1st or when spaces are full.