Lyme Summer Recreation
Pond Program 2010
Once again the Lyme Summer Pond Program is being offered to the children of Lyme!
When:
Week 1: June 21 - June 25
Week 2: June 28 - July 2
Week 3: July 5 - July 9
Week 4: July 12 – July 16
Where: Chase Beach at Post Pond
Cost: $55 per week per child
* Families with three or more children enrolled, $40 per week per child.
* Please ask about scholarships, they are available on need be basis. Please contact Torey Cutting for an application!
Who can join: Any child age 4 (by December 31st, 2010) through fifth grade.
Hours: 8:30 am- 12 Noon
Activities available: Red Cross swimming lessons, sports, arts and crafts, drama, read aloud and group free choice.
All camper forms due by June 5, 2010!
*More information is available on the Town website for campers and counselors*
Please contact Torey Cutting, Pond Program Director at
Pond Program Registration
Lyme Summer Recreation
- Your child(ren)’s name, birth date and grade entering in the fall:
Child’s Name__________________________DOB_______Grade in Fall_____
Child’s Name__________________________DOB_______Grade in Fall_____
Child’s Name__________________________DOB_______Grade in Fall_____
Child’s Name__________________________DOB_______Grade in Fall_____
- Parent or Legal Guardian(s): __________________________________
- Daytime contact numbers: (H)__________________(W)__________________
- Person(s) authorized to pick up your child(ren) and their contacts:
Name: _________________________ Phone Number: __________________
Name: _________________________ Phone Number: __________________
- Physician’s Name: ___________________ Phone Number: ________________
- Medical Conditions, allergies or medical issues that the staff needs to be aware of:
____________________________________________________________________________________________________________________________________
I authorize the persons in charge to administer first aid and/ or CPR in an emergency.
Parent Signature ______________________________ Date ______________
POND PROGRAM FEES: Pond Program costs $55 per child per week.
Families with three+ children; $40 per child per week.
Scholarships are available by request from parents.
Please indicate the week(s) that your child (ren) will attend the program (circle):
Week 1: June 21 - June 25
Week 2: June 28 - July 2
Week 3: July 5 - July 9
Week 4: July 12 – July 16
Please make checks payable to the Town of Lyme and mail this form to:
Torey Cutting
391 Dogford Rd.
Etna, NH 03750
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