Barkhamsted Recreation Halloween Sock Hop 2022 (Friday, October 28 from 5-7 p.m. at the Mathies Grove Pavilion-105 East River Road Barkhamsted at Peoples State Forest the event will be rain or shine) Cost is $6.00 per person and $25.00 max per family) Please bring exact amount so contact is reduced for safety (All children must be accompanied and supervised by an adult family member/caregiver. The dance is for the entire family and prizes are awarded for best costumes for children, adults and families!! (Please bring a flashlight or headlamp and exact fee for the dance for everyone that attends.)

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First and Last Name of Parent(s)/Caregiver(s) that are attending *

First and Last Name of Children Attending with Grade? *

Total Number of people in your group attending including parents/caregivers *

Home Address (Street, City, Zip) *

Home Telephone Number *

Parent Cell Phone Number/Emergency Number *

List any allergies, medical conditions or special assistance that you or any of your family members may need. Please be specific. If none, list 'None'. This information will remain confidential and is for staff only if necessary. PLEASE BE SURE TO LIST ANY FOOD ALLERGIES. *

Waiver of Participation by Parent/Guardian

I GIVE MY SON/DAUGHTER, SELF and FAMILY PERMISSION TO PARTICIPATE IN THE BARKHAMSTED RECREATION DEPARTMENT'S PROGRAM. TO THE FULLEST EXTENT PERMITTED BY LAW I AGREE TO INDEMNIFY AND HOLD HARMLESS THE TOWN OF BARKHAMSTED AND ITS EMPLOYEES, STAFF AND VOLUNTEERS FROM ANY INJURIES OR DAMAGES CAUSED BY OR RESULTING FROM PARTICIPATION BY IN THE TOWN OF BARKHAMSTED RECREATION DEPARTMENT’S PROGRAM.

PHOTO/VIDEO RELEASE: I understand that for promotional purposes only, the Town of Barkhamsted photographs, and/or records video of participants enrolled in recreational activities, classes or at special events. I hereby release and permit the Town of Barkhamsted to utilize for said promotional purposes any photographs and/or videotapes of me or my minor child engaging in the above-listed recreational activities.

Please understand that regardless of all of the safety measures and precautions that will be taken, it is not possible to guarantee a COVID-19 free environment, COVID-19 is now a risk that is inherent in everyday life. By participating in, and allowing your child to participate in Recreational activities, you hereby accept the risk that you/or your child may be exposed to, and possibly contract COVID-19.

I understand and accept that Barkhamsted Recreation relies on the honesty and truth of all of the program participants that they are not doing so while they, or any member of their household are sick or are feeling COVID-19 symptoms. Neither, or anyone in my household, currently has or feels any symptoms of COVID-19. If this changes before the recreation event, I and my family will not attend.

Do you agree to the above Waiver of Participation? An answer of 'yes' is required to be able to participate. *

Yes

Printed Name of Parent/Guardian - this serves as an official signature *

FEE AND INFO ABOUT PRE-Registration

All participants must pre-register. No walk-ins the day of the event will be allowed. Please only register if you know that your family will be attending. The $6.00 Fee per participant will be collected at the event. Please bring the exact fee owed to the Sock Hop to help make the registration run smoothly. The Sock Hop will be held rain or shine (only a severe storm would cancel the event). In the event of a severe weather cancellation, registrants will be contacted. Please dress warmly and bring a flashlight or headlamp as it will be dark when the event is ending. (in the event that you cannot attend the dance after you register, please email Donna Bastrzycki- barkhamstedrec@barkhamsted.us so we can take any families that may be on the waiting list)

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