Kid's Night Out
 
Dates: Friday, November 2 
Time: 5:30P-9P
Ages: Children Ages 6-14
Fee: $25 per child
Location: Hamel Recreation Center, 5 Edgewood Rd, Durham, NH 03824

Join Campus Recreation youth program staff for an evening of group games, sports, crafts, and dinner. The program runs from 5:30P through 9P for children ages 6 through 14 at the Hamel Recreation Center. Cheese pizza will be served for dinner. Detailed information regarding drop off, pick up, and what to bring will be sent on Thursday, November 1.

                              Parent/Guardian Information

Parent/Guardian First Name

(required)

Parent/Guardian Last Name

(required)

Cell Phone

(required)

Home Phone

(required)

Work Phone

(required)

E-mail Address

(required)

Mailing Address

(required)

Affiliation 

(required)
                                     Participant Information

Participant First Name

(required)

Participant Last Name

(required)

Gender

(required)

Date of Birth

(required)

Age (as of September 29, 2017)

(required)

Date of last Tetanus Shot

(required)

Would you like to register a second child?

                                     Participant #2 Information

Second Participant First Name

(required)

Second Participant Last Name

(required)

Gender

(required)

Date of Birth

(required)

Age (as of September 29, 2017)

(required)

Date of Last Tetanus Shot

(required)

Would you like to register a third child?

                                     Participant #3 Information

Third Participant First Name

(required)

Third Participant Last Name

(required)

Gender

(required)

Date of Birth

(required)

Age (as of September 29,2017)

(required)

Date of Last Tetanus Shot

(required)

We require that the following forms be reviewed by a parent/guardian prior to a minor's participation in a UNH youth program. Click on the name of each waiver to open the form in a new browser. Please review each waiver and attest that as the parent/guardian, you have read and agree to the terms and conditions of each.

                       Photo/Creative Works Permission

(required)

                                               Permission to Treat

I have read and agree to the Permission to Treat terms

(required)

                                   Assumption of Risk Waiver

I have read and agree to all terms in the Assumption of Risk Waiver

(required)

                                                   Code of Conduct 

I have read and agree to all terms in the Code of Conduct

(required)

Parent or Guardian: Please type your name into the box. By doing so, you are certifying that you are the parent or legal guardian of the minor participating in the UNH youth program, and you understand and are in agreement with the waivers as marked above.

(required)

Emergency Contact Information (Other than Parent/Guardian Information)

Emergency Contact #1

(required)

Relationship to Participant(s)

(required)

Phone #

(required)

Emergency Contact #2

(required)

Relationship to Participant(s)

(required)

Phone #

(required)

In addition to the above emergency contacts, please list up to 5 additional adults who are authorized to pick up your child(ren). The designated adult(s) must provide photo identification in order to sign out your camper(s) on a daily basis.

Adults Authorized to Pick up
(First & Last Name of Each Adult separated by Commas) 

Medical/Health Information

Does the participant(s) have any health/medical conditions?

(required)

If yes, please explain:

(required)

If yes, please explain

(required)

Does the participant(s) have any allergies?

(required)

If yes, please explain

(required)

Will the participant bring an Epi-pen and/or Asthma Inhaler to the program?

(required)

                                                                          Epi Pen Form 

                    Please mail or fax this back prior to the start of the program

                                          Program Accommodations 

The University of New Hampshire seeks to create a welcoming and inclusive experience for all participants. If an accommodation is required for any reason, please note the concern in the following text box.

Please contact Kay Lewis, Coordinator of Instructional and Youth Programs, 603-862-7062 (phone) or kayode.lewis@unh.edu for additional information. Accommodation request determinations are made on a case by case basis. Accommodation requests should be made at the time of registration, or as soon as possible thereafter to allow sufficient time for consideration and implementation.

Payment Options

Pay Online

Pay online using Visa, Mastercard, or E-check. If you choose to only pay the deposit now you will receive an email with instructions on paying the balance in full at a later date.