SUMMER PLAYGROUND REGISTRATION FORM

Lancaster Recreation Commission
SUMMER PLAYGROUND REGISTRATION FORM

The Summer Playgrounds & Wading Pools program is a FREE, 8-week drop-in program for youth ages 6-13. Children under age 6 are welcome but must have a parent or guardian present. Playgrounds are open Monday through Friday 11:30 am to 4:30 pm., with free lunch and snack served for all children 18 and under. For locations, program rules and more information, please visit Lancasterrec.org.
Child's Name*
Children under age 6 must have a parent attend with them.
Date of Birth*

MonthDayYear
Date
Allergies*
YesNo
If yes please list medications*
YesNo

Child's Name*
Children under age 6 must have a parent attend with them.
Date of Birth*

MonthDayYear
Date
Allergies*
YesNo
If yes please list medications*
YesNo

Child's Name*
Children under age 6 must have a parent attend with them.
Date of Birth*

MonthDayYear
Date
Allergies*
YesNo
If yes please list medications*
YesNo

Child's Name*
Children under age 6 must have a parent attend with them.
Date of Birth*

MonthDayYear
Date
Allergies*
YesNo
If yes please list medications*
YesNo

Family Information
Child's Home Address*
Home Phone*
Format: (000) 000-0000.
Both ParentsMotherFatherLegal Guardian
Mother/Guardian Name*
Father/Guardian Name*
Daytime Phone*
Format: (000) 000-0000.
Daytime Phone
Format: (000) 000-0000.
Email*
example@example.com
Email
example@example.com

Emergency Contact Information (parent/guardian not available)
Name*
Cell Phone*
Format: (000) 000-0000.
Relationship to Child*
Name
Cell Phone
Format: (000) 000-0000.
Relationship to Child
Family Doctor - Practice Name*
Family Doctor - Phone Number*
Format: (000) 000-0000.
Dentist Name
Dentist Phone Number
Format: (000) 000-0000.

Waiver of Liability: I hereby give permission for my child(ren) to attend the Lancaster Rec playground program and to participate in all playground activities. I understand that Lancaster Rec neither assumes nor accepts any responsibility for bodily injury or property damage while participating in the playground program. I understand that my child must comply with the rules and regulations of the playground program. If my child needs emergency medical care and no parent/guardian or emergency contact can be reached, I give my consent for the transportation of my child by ambulance and for the administration of any treatment deemed necessary by a medical professional. I also understand that Lancaster Rec may use any photographs or video tape of me or my child for promotional purposes.
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Date
**Reminder: Children 5 years of age and younger must be accompanied by an adult.**

PARENT/LEGAL GUARDIAN RESPONSIBILITIES

THIS PAGE MUST BE RETURNED WITH THE PLAYGROUND REGISTRATION FORM. IF THIS FORM IS NOT ON FILE, YOUR CHILD(REN) WILL NOT BE ALLOWED TO PARTICIPATE IN THE PLAYGROUND PROGRAM.

1. The playground program is not a babysitting service; please do not treat it as such.

2. Children are free to come and go as they please. We are not responsible if your child leaves the playground without your permission.

3. Masks are optional and participants must wash their hands before entering the pool area.

4. Participants should practice social distancing and refrain from socializing with individuals outside of their household.

5. Playground leaders remain at the playground only until closing time. Leaders will leave at closing time even if children have not been picked up.

6. You must be aware of the weather at all times and instruct your child on what to do or pickup your child if severe weather occurs. The playground closes during severe weather. (See Inclement Weather Rules

7. NO SMOKING OR ALCOHOLIC BEVERAGES ARE PERMITTED ON THE PLAYGROUND.

If you have any questions about or an issue with the playground program or staff, please contact the Lancaster Recreation Commission at 717-392-2115.

I understand the responsibilities listed above and the playground rules and regulations. I understand that it is my responsibility to ensure that my child(ren) understand the rules and regulations and if my child does not follow the rules, he or she may lose their playground privileges.
Parent/Legal Guardian Name*
Parent/Legal Guardian Signature*

Clear
Date*

MonthDayYear
Date

SUMMER PLAYGROUND AND WADING POOL RULES AND REGULATIONS

Please retain these rules and regulations for your information!

1. All children must be registered in order to participate in playground and wading pool activities. A completed and parent/guardian signed registration form must be submitted, along with a parent/guardian signed responsibilities form.

2. Participants are expected to follow the rules and commands given by the playground leaders whileat the playground and wading pool program. Talking back, swearing, spitting, stealing, fighting, and unwillingness to cooperate or follow instructions will not be tolerated.

3. The playground and wading pool program is a drop-in program for children ages 6 to 13. Playground leaders are not responsible for the coming and going of children to and from theplayground.

4. Bringing guns, tasers, knives, pepper spray, mace, nail clippers, nail files or any other item that may be used as a weapon to the playground is strictly forbidden.

5. Climbing of fences, trees, roofs or equipment not designed for climbing is not permitted.

6. Jumping or standing on tables, benches and play equipment is not permitted.

7. Abuse or marking of buildings, fences, picnic tables or other equipment is not permitted.

8. Throwing of sticks, stones, woodchips, food, or playground supplies is not permitted.

9. Be respectful of playground property, use check-out sheets and return all equipment at the end ofthe playground session.

10. Be respectful of other children on the playground. Name-calling, threats of violence, harassmentand bullying will not be tolerated.

11. Pets must be left at home.

12. Children must use hand sanitizer or wash hands prior to receiving food.

13. Food must be eaten in the designated area and cannot be taken off the playground.

14. Unopened food that is not wanted must be placed on the share table.

15. Children under 6 years of age must be accompanied and supervised by an adult while at the playground program. The adult must be within an arm's reach of young children in the wadingpool.

16. Proper swimming attire must be worn in the wading pool. Swim diapers are required for allchildren 3 years of age and younger.

17. Parents with children 6 years of age and older are not permitted in the wading pool, but may sit onthe side with feet in the pool.

18. No diving, running, pushing, sliding on rails, horseplay, glass bottles, food, playing with pool filters, bike riding, and metal or hard objects is permitted in the wading pool area.

19. All trash must be thrown in the trashcans provided after lunch and snack. All children will berequired to participate in picking up trash if the playground does not remain clean.

20. Children will help to keep the bathrooms tidy by keeping paper towels, toilet paper and other trash off the floor, flushing after using the toilets and turning off the water after washing hands.

21. No smoking or alcoholic beverages are permitted on the playground.

22. Committing any type of physical harm to another will be, at a minimum, an automatic three (3) daysuspension from the playground.
CONSEQUENCES OF RULES VIOLATION

1. First Offense - warning or child asked to leave playground, depending upon the nature of the offense. The police will be called if child does not leave the playground when directed to do so by playground leaders. 2. Second Offense - three (3) day suspension from the playground; parents called. 3. Third Offense - suspension from the playground for the season; parents called.

If a child is suspended, they may not attend other playgrounds. The rules violation consequences will be accelerated for serious offenses.

IMPORTANT NOTE: Lancaster Rec staff is responsible for supervision of the children registered in the playground and wading pool program only. We do not supervise the entire park. We will call the police if actions of other park users threaten the safety of the children in our program.

1. Structures on the playground do not provide adequate protection in severe weather conditions. The playground will not open or will close immediately if: The National Weather Services (NWS) issues for our area A thunderstorm warning A tornado warning There is any indication (thunder, lightning, heavy rainfall) of a storm

2. WALKERS - Parents should instruct their children:

To listen to the leaders and immediately leave the playground if it closes due to inclement weather. Where they should go (home, to a neighbor's home, or with a friend) if the playground closes.

3. DROP-OFFS - Parents should:

Monitor weather conditions and promptly return to pick up their children if severe weather is occurring or there is a NWS warning. Children will be permitted to call parents to let them know the playground is closing. Parents must instruct their children on who to call to pick them up and children must know the phone number. A leader will remain at the playground for 30 minutes after the decision is made to close. The playground leader will leave after 30 minutes even if children have not been picked up.

IF PARENTS HAVE ANY QUESTIONS ABOUT THE RULES OR APPLICATION OF THE RULES, PLEASE CONTACT THE LANCASTER RECREATION COMMISSION OFFICE AT 717-392-2115.
Name of participant*
Participant signature*

Clear
FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION)
This is to certify that I, as parent/guardian, with legal responsibility for this participant, have read and explained the provisions in this waiver/release to my child/ward including the risks of presence and participation and his/her personal responsibilities for adhering to the rules and regulations for protection against communicable diseases. Furthermore, my child/ward understands and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child/ward do release and agree to indemnify and hold harmless the Releasees for any and all liabilities incident to my minor child's/ward's presence or participation in these activities as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent provided by law.
Name of parent/Guardian*
Parent/Guardian signature*

Clear
Culliton ParkBuchanan ParkKing ElementaryReservoir ParkRodney Park6th Ward Park
Should be Empty:

SUMMER PLAYGROUND REGISTRATION FORM

Family Information

Emergency Contact Information (parent/guardian not available)

FOR PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION)