The
Trip
Derry Resident Fee: $20.00
Accepted Beginning Monday, Feb 9, 2015
Non-Resident Fee: $30.00
Accepted Beginning Monday, Feb 23, 2015
Join the Derry Parks & Recreation Department for a fun-filled day with
your friends and family in BOSTON during April Vacation!
Enjoy a comfortable ride on a Coach Bus to the City Hall Plaza for a
spectacular show by the Big Apple Circus. Watch in amazement as the circus
comes to life right in front of your eyes. Look for clowns, trapeze artists,
jugglers, contortionists, a Ringmaster like no other, and much, much more!
And remember, no one sits more than 50 feet from the ring!
Afterwards, travel to Historic Faneuil Hall in Boston. Enjoy a wide variety of
amenities that you and your family can enjoy together including shops,
restaurants, live music, and more!
Bus pick-up Location is Hannafords, Derry
And begins at 9:00 AM /Bus Leaves at 9:15 AM
Approximate return to Derry at 4:30 PM
**There are no assigned bus seats on this trip. **
Please call if you require a bus seat accommodation.
$1.00 per participant gratuity for bus driver suggested & collected at end of trip.
For more information, please contact the Derry
Parks and Recreation Office at (603) 432-6136
Big Apple Circus Trip
Wednesday, April 29th, 2015
31 West Broadway, Derry, NH 03038
Phone: (603) 432-6136
Fax: (603) 432-6758
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All children under 18 must be accompanied by an adult
The per person fee applies to all ages and participants
This trip requires walking on uneven ground, climbing stairs, etc. If you require assistance with these tasks,
please speak with an office employee prior to registration to ensure proper accommodations can be made.
Lunch is on your own at Faneuil Hall after the performance (to conclude at approximately 12:30pm)
Fees are as follows:
Derry Resident Fee: $20.00 per person
Registrations begin February 9th, 2015
Non-resident Fee: $30.00 per person
Registrations begin February 23rd, 2015
*Suggested $1.00 per participant gratuity for bus driver suggested & collected at end of trip.
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Parent/Guardian Name:
Address:
Town:
State:
Zip Code:
Primary Phone:
Gender:
Emergency Contact:
Emergency Contact Phone 1:
Emergency Contact Phone 2:
List each additional person attending who resides in your household:
NAME
1.
2.
3.
4.
AGE
WAIVER
Participation in this sport/activity may involve risk of injury. As a parent/guardian/participant I am aware of these hazards and of the ability to participate. In
consideration for participation in this program, I hereby for myself, my heirs, executors, and administrators waive and release all rights and claims against the Town of
Derry, Derry School District, its officers, employees, agents, volunteers, supervisors from all losses, injury, damages, fees, and other expenses, arising out of or in
connection with participation in the activity/sport. The above named cannot be responsible for any aggravation or injury caused as a result of pre-existing physical
disabilities; including, but not limited to, allergies. The Parks & Recreation Department will be notified of any such special needs or sensitivities in writing prior to
enrollment in this program. I understand the cancellation/refund policy of the Parks & Recreation Department. The Department encourages you to carefully
consider your schedule prior to registration. No fee will be refunded after the program has begun. This policy is strictly enforced thereafter.
Participant Signature
Date
Recreation Employees Only:
Employee Initials: ______________
Cash or Check
Check #: _______________
Amount: ___________
Accommodations Requested? : ________________________________________________________________