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2. CAMPER REGISTRATION FORM
4. *Please note that immunization records and a photo of your child are required in order to submit your child's form. Please have these files ready when preparing to submit.
6. Please check the week(s) of camp that your child is registered for this summer. Registration and payment must be completed at https://register.communitypass.net/SpartaTownship before submitting this form. *

   1. Week One (June 30-July 3)
   2. Week Two (July 7-July 11)
   3. Week Three (July 14-July 18)
   4. Week Four (July 21-July 25)
   5. Week Five (July 28-August 1)
   6. Week Six (August 4-August 8)
8. CAMPER INFORMATION
10. Camper Name (First and Last)*
12. Address*
14. City*
15. State*
16. Zip Code*
18. Birth Date*
19. Grade Level as of Fall 2025*
23. PARENT/GUARDIAN INFORMATION
25. Custodial Parent or Guardian # 1
27. Name (First and Last)*
29. Address (If different from child's address listed above.)
31. City
32. State
33. Zip Code
35. Email Address*
37. Phone Number*
39. Custodial Parent or Guardian # 2
41. Name (First and Last)
43. Address (If different from child's address listed above.)
45. City
46. State
47. Zip Code
49. Email Address
51. Phone Number
53. If a non-custodial parent has been denied access, or granted limited access, to the child by the court order, please supply documentation to this effect. In addition to submitting this form, please call our office at 973-729-2383 to confirm we received this documentation.
57. PERSONS AUTHORIZED TO PICK UP CHILD FOR CARPOOLING PURPOSES AND/OR CONTACT IN CASE OF EMERGENCY IF PARENTS ARE NOT AVAILABLE:
59. # 1 Name (First and Last)*
61. Relationship to Child*
62. Phone Number*
64. #2 Name (First and Last)
66. Relationship to Child
67. Phone Number
69. # 3 Name (First and Last)
71. Relationship to Child
72. Phone Number
76. INSURANCE INFORMATION & CONSENT TO TREAT
78. Is the participant covered by family medical/hospital insurance?*

    1. Yes
    2. No
80. Indicate carrier of plan name*
81. Group Number*
85. HEALTH HISTORY/ALLERGIES
87. List all known allergies: MEDICATION
89. Describe reaction and management of the reaction.
91. List all known allergies: FOOD
93. Describe reaction and management of the reaction.
95. List all known allergies: OTHER (Include insect stings, hay fever, etc.)
97. Describe reaction and management of the reaction.
99. Please describe any medical information that camp staff or a doctor treating participant should be aware of, including prescription drugs, pre-existing conditions, disabilities or restrictions to activity. (Please note: camp staff will NOT administer any medication.)
101. Explain any additional information about the participant's behavior, emotional or mental health of which the camp staff should be sensitive to or aware of.
103. IMPORTANT-PLEASE READ AND SIGN-CONSENT TO TREAT

     This is to certify that I, the undersigned, as parent or guardian of the above-named participant, give my consent to the Township of Sparta, the personnel thereof, and the medical and other representatives thereof, to obtain medical care from any licensed physician or other qualified emergency or non-emergency medical personnel, or a hospital or medical clinic, for the above-named participant for any injury that could arise from participation in the activities of the Sparta Recreation Summer Day Camp Program, including all activities and other events, and functions directly or indirectly related thereto, whether on or off property of the Township of Sparta.  It is understood that if only one parent or guardian is signing this consent to treat, the signing parent or guardian hereby certifies that he or she is signing on behalf of and with the full consent of any other parent or guardian, and will indemnify all parties against any actions or claims brought by any non-signing parent or guardian. 

105. By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date*

     1. I Agree
107. First and Last Name of Parent/Guardian Completing This Form. *
108. Date*
110. Upload your child's current IMMUNIZATION RECORD here.*
112. Upload a current PHOTO of your child here.*
Leave This Blank:


113. 1. Receive an email copy of this form.
114. Email address

     This field is not part of the form submission.

115. Submit

* indicates a required field