American Red Cross Babysitting Course
(please use one form per person)
Hopkinton Parks and Recreation Department
330 Main Street
Hopkinton, NH 03229
Name _______________________________Phone # _____________________
Address _____________________________________________________________
Date of Birth___ /____/____
Emergency Contact _____________________~ Phone # _______________
Classes will be held from 12:30pm-4:30pm on Thursday & Friday
June 5 & 6 (early release days).
at Columbia Hall (14 Maple Street)
price: $55
Please make check payable to “Hopkinton Recreation Department”
I hereby release the Town of Hopkinton, its employees and agents from any liability or personal injury, or the loss or damage to personal property, which I or my child may experience in connection with any activities sponsored by the Hopkinton Parks and Recreation Department. I hereby consent to any medical procedures deemed advisable for my child in the event I cannot be reached and my child has sustained an injury.
________________________________________________ ____________
Signature of Participant / Parent or Guardian Date
Parent’s Name __________________ Work Phone____________
Registration forms can be mailed to the Recreation Department at the above address or returned to the Recreation Department Office
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