Event Participation Form

ARE YOU A DEVILS FAN?
COME WITH FRIENDS OR FAMILY
AND SEE THE NEW JERSEY DEVILS
PLAY THE COLUMBUS BLUE JACKETS
FRIDAY, MARCH 6!
Meet in the Westfield Area Y Main Lobby at 5:00PM
Pickup at Westfield Train Station (time TBD based on game end
time). Parents will be called for pickup time.
$75 fee includes transportation, game ticket, $10 food voucher
and Y adult chaperone counselors (grades 4 and up do not need
a parent)
Y membership is not required … so invite a friend!
Register online or at the Welcome Center by 2/27(prog. #:
1TNDEVILSMAR)
Event Participation Form with parent signature required.
Questions? Contact Marty Collett at 908-233-2700 x405 or collett@westfieldynj.org
WESTFIELD AREA Y ▪ visit us at westfieldynj.org
Main Y Facility ▪ 220 Clark St., Westfield, 908-233-2700
I give my child,_________________________________ ,permission to attend the Westfield Area Y Harlem Devils Trip on
March 6, 2015 I understand that you will be traveling via NJ Transit train and leaving from the Westfield Area Y at approximately 5:30 you will be returning to the Westfield Train station between 10:00pm and 11:00pm( all parents will be
called about pickup on train ride home. ) I also understand that the cost of the trip covers admission into the show, transportation, $10 food voucher for the Prudential Center and chaperones. I will send my teen with money to purchase additional food and or souvenirs if they desire. Parents are invited to inquire about chaperone availability. All chaperones are
responsible adults, college age or older and will remain with their designated group (10 or less) for the entire
event. Parents and/ or other adults are welcome
Credit / Refund Policy: Registration Fees are non-refundable. In the event you need to cancel your teen’s registration
you must do so at least 6 days before the trip (March 6) and you will receive a credit, minus a $10 administrative fee. No
credits will be issued if cancellation is done later than specified. Trips may be cancelled due to low enrollment or poor conditions resulting in a full refund of your payment.
I understand that if I cannot be reached in an emergency, that the Y’s nurse/EMT or a local hospital/rescue squad
will be sought for my teen and that repeated efforts will be made to contact me in that situation. I’ve included below, some
contacts in case of an emergency.
I give the Y permission to photograph my teen during the trip for use of publicity in their website, brochure, newsletter, or local newspaper.
________
init.
I agree to hold harmless the agents and employees of the Westfield Area Y of any and all liability arising from participating in any activity or use of equipment or facilities.
Cash, check and credit cards accepted. Payment and registration must be submitted at the Y’s Welcome Center no
later than February 27, 2015.
Thank you,
Marty Collett
Director of Youth, Camp & Teen Services
Westfield Area Y
908-233-2700 Ext. 405
mcollett@westfieldynj.org
__________________________________ _________________
Parent/Guardian Signature
_____________________________________________________
Date
P/G Email
______________________________ ______________________________ ___________________________________
Parent / Guardian Name
Home #
Cell #
(Please Print)
_______________________________
Emergency contact (other than above p/g)
__________________________
Cell #
_____________________________
Relation
_______________________________
Emergency contact (other than above p/g)
__________________________
Cell #
_____________________________
Relation
Any other important information we need to know (allergies, medications etc.)
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
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