WRD Archery 2024 Registration Form
To register for the Westford Recreation Department Pelkey's Archery Program, please complete ONE FORM PER PARTICIPANT.

Limit of 12 participants.  We expect this will fill fast.  Please wait for a direct e-mail from recreation@westfordvt.us before believing you are in!

Registration due by May 1, 2024

Mondays June 17th & 24th 

4:30 p.m. - 5:30 p.m. at Westford Elementary School

Ages 5 and over           $50 fee per session, equipment provided.

If you have questions or would like to request more information about this event, email us at recreation@westfordvt.us

Thank you, Westford Residents (and residents in nearby towns) for your participation in our programs.  We appreciate you and look forward to seeing you enjoy this event.

Westford Recreation Board
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Participant's Full Name *
Mondays June 17 & 24
Primary Address *
Email Address *
Primary Phone # *
Emergency Contact Name & Phone # *
Please List medical conditions of the participant(s), physical limitations, allergies, or restrictions WRD should be aware of.  If there are none, please type 'none': *
Are you interested in donating to the Scholarship Fund? If so, please select an amount.
Release/Waiver Agreement: I am fully aware of the inherent risk, and give my consent for the above named applicant(s) to participate in the program(s) listed above.  I hold harmless the Town of Westford, Westford School, their employees, elected officials, and/or any volunteers or instructors from any and all liability from any injury, claim, costs or loss of services which may be incurred by me, or us, or our minor children on account of participation in said program(s).  Permission is hereby granted for me or us, or my child(ren) to receive emergency treatment if needed and I authorize the attending physician to administer any needed medical attention.  Furthermore, I certify that I, or we, or my child(ren) are in good health and that there are no limitations to my/our participation except in writing above.  I have read this document carefully and sign it voluntarily with full knowledge of its significance.  By clicking below, I release the Westford Recreation Department from all liability relating to injuries that may occur. *
Name as Signature  to Release/Waiver Agreement (Parent/Guardian if under 18)
 *
Photo Release: I give the Westford Recreation Department permission to photograph and use myself/my child's image in its publications or on social media. *Your name and your child's name will NEVER be included with their image. *
COVID-19 Agreement: To ensure the health and safety of all participants, volunteers, and their families, I agree to the following:  A personal health check will be completed within an hour BEFORE participating in any Westford Recreation Department program. Have you been in close contact with a person who has COVID-19? Do you feel unwell with any symptoms consistent with COVID-19? For example, have you had a cough, high temperature, shortness of breath, difficulty breathing, chills, repeated shaking with shills, muscle pain, headache, sore throat, or new loss of taste or smell?  Take temperatures prior to arrival.  Does the temperature exceed 100.4 F ?If the answer to any of these questions are Yes, DO NOT attend the program. Maintain social distancing, whenever possible. No sharing of personal equipment, water bottles, clothing, etc. Shared program equipment will be sanitized between sessions.  Hand sanitizer will be available. Wash your hands before and after programs. Masks are NOT required. COVID-19 restrictions are constantly changing.  Please adhere to the CDC and Vermont State Guidelines *
Name as Signature to Photo Release and Covid-19 Agreement (Parent/Guardian if under 18) *
Fee can be paid via card, cash or check.  Make checks payable to: WESTFORD RECREATION DEPARTMENT, write "Archery" on the memo line.

I will submit payment via: *
Scholarship Fund:  If your financial situation is preventing you from signing yourself or your child up for this activity, please write a brief essay in lieu of a fee.  The Recreation Department Committee will review eligibility for a scholarship & contact you.
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