Parisi Speed School Summer Program

Parisi Speed School Summer Program

At the Fairfax Community Park
Program is for students entering grades 5-8. These 1-hour lessons will work on buliding speed and injury prevention. Classes will take place on Tuesday and Thursday evenings from 5:30 - 6:30 PM. Starting the week of June 23rd and going until July 31st.

Each individual class is $20. If you would like to sign up for all 12 classes the total will be $180 (savings of $60).

Please submit only one application form for each child you register. If there is an issue with the form you submitted, please contact Danielle at recreation@fairfax-vt.gov instead of submitting a duplicate form.
Child Information
Child's Name*

First NameLast Name
Child's Date of Birth*

MonthDayYear
Date
What Grade is your Child entering in the fall of 2025?*
Child's Gender*

Prefer not to sayMaleFemaleOther
Please list all known allergies your child has*
Please list any dietary restrictions your child has*
Please list any medications your child takes*
Does your child require modifications to be made to the program or accommodations to participate? If so, briefly describe and we will be in touch.
Week Selection

Select the weeks which you'd like to register your child for our day camp - if a certain week is listed as "[FULL]" we will add them to a waiting list for that week if selected. Each week of camp is $150. Please remember that a $25 non-refundable deposit is due for each week you select by April 1st (weeks you select that are already full will not require a deposit or commitment until we can add you to that week of camp)
Which days would you like to register your child for?*

Tuesday June 24thThursday June 26thTuesday July 1stThursday July 3rdTuesday July 8thThursday July 10thTuesday July 15thThursday July 17thTuesday July 22ndThursday July 24thTuesday July 29thThursday July 31st
Contact Information
Primary Parent or Guardian Name*

First NameLast Name
Primary Phone Number*
Please enter a valid phone number.
Secondary Phone Number*
Please enter a valid phone number.
Primary Email*
example@example.com
Primary Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact (Cannot be the same as Primary)*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Emergency Contacts Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional person who has permission to pick up this child

First NameLast Name
Additional person's phone number
Please enter a valid phone number.
Permissions
RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, INDEMNITY, AND PARENTAL CONSENT AGREEMENT

I hereby release and discharge the Town of Fairfax, it's agents, employees, staff members, directors, and volunteers from any claims, responsibilities or liabilities for injuries or harm incurred as a result of my child's involvement as a participant in programming through the Town of Fairfax.

I accept that allowing my child to participate in educational, instructional or recreation activities includes risks. These activities may be led or conducted by staff, contracted staff or others, and may include but are not limited to: Interactive games and other sporting activities; Use of any equipment, facilities or premises; and travel by foot.
Signature*

Clear
Date (Today's Date)*

MonthDayYear
Date
MEDICAL RELEASE

I hereby grant consent to any and all health care providers designated by the Town of Fairfax to provide my child with any necessary medical care as a result of any injury or illness. This consent includes First Aid and CPR administered by staff of the Town of Fairfax and transportation by Fairfax Rescue to the hospital.

If an emergency should arise, I understand that a thorough effort will be made to contact me or or an emergency contact before action is taken, but I agree to accept any expense associated with such an emergency if it is not possible to contact me in advance of treatment.
Signature*

Clear
Date (Today's Date)*

MonthDayYear
Date
PERMISSION TO ATTEND PROGRAMMING

I, Parent / Guardian of the participant, authorize him / her to attend a program with Fairfax Parks & Recreation.

I give permission for listed individuals to pick up my child. I understand that these people will be asked for identification if not recognized by camp staff members. I additionally acknowledge that my child will not be released to any person other than those I have listed.
Signature*

Clear
Date (Today's Date)*

MonthDayYear
Date
Payment
We will contact you within 48 hours of registration submission (Monday - Friday) to organize payment with you.
Additional Notes

Please enter any additional information about your child you think we should know
Notes or Comments
Should be Empty:

Parisi Speed School Summer Program

Child Information

Week Selection

Contact Information

Permissions

Payment

Additional Notes