2025 Summer Fun Program Registration

SUMMER FUN PROGRAM REGISTRATION
We appreciate your interest in our program! Please read through the following details prior to completing this form:
- The program takes place Monday - Friday from 10 am - 2 pm starting June 9 and ending August 1.
- The program will not meet the week of June 30 due to the holiday.
- The program location is Chesterton Park. The building near the playground serves as the "hub" for the program. Other areas of the park are also utilized for activities.
- The program is for kids in grades 2 and above.
- Activities include various games, sports, arts and crafts, special guests, Friday Hot Dog Roasts, and more.
- Snacks are provided at the park for a nominal fee. Kids are also welcome to bring their own.
- Our staff uses the Remind App to send out updates and information regarding cancelations. Please send a text to 81010 and text this message: @25chespark.
- We also provide updates on the Chesterton Parks & Recreation Facebook Page at www.facebook.com/chestertonparks.
PARENT/GUARDIAN INFORMATION
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
ALTERNATE EMERGENCY CONTACT

Please provide an alternate emergency contact for your child.
Emergency Contact Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Relationship to child:*
PARTICIPANT INFORMATION

Please provide participant information in this section.
Child Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade*
2025 - 2026 Academic Year
Name of School
PHOTOGRAPHY RELEASE
I give permission for the use of names and photographs in the Town of Chesterton Parks and Recreation Department's publications both print and electronic as well as promotional displays set up by the department.I DO NOT give permission for the use of names and photographs in the Town of Chesterton Parks and Recreation Department's publications both print and electronic as well as promotional displays set up by the department.
PROGRAM WAIVER & RELEASE
I, the undersigned participant, or parent or guardian of a participating minor child, acknowledge the risk of personal injury, death, damage and loss associated with participation in any and all activities associated with the above program(s). I assume the full risk of personal injury, death, damage and loss associated with participation in any and all activities associated with this program(s). In consideration of the permission to participate granted to me or my child or ward, I hereby release the Town of Chesterton, Indiana and their respective officers, agents, and employees, (collectively “Chesterton”) from any and all actions, causes of action, damages or claims which I, my heirs, executors, administrators, or assigns, or my child’s/ward’s heirs, executors, administrators, or assigns, may have against Chesterton for any personal injuries, death, damage, or loss resulting from, or in any way associated with, participation in this program(s). I, the undersigned participant, or parent or guardian of a participating minor child, have read this waiver and release and fully understand the terms of same and the details of the program(s). I execute this waiver and release with the full knowledge of its terms and significance.
Signature*
Date*

MonthDayYear
Date
Should be Empty:

SUMMER FUN PROGRAM REGISTRATION

PARENT/GUARDIAN INFORMATION

ALTERNATE EMERGENCY CONTACT

PARTICIPANT INFORMATION

PHOTOGRAPHY RELEASE

PROGRAM WAIVER & RELEASE