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WVRD School Year Registration Form & Waiver 2023/2024

Waterville Valley Recreation Department

Youth Program Behavior & Discipline Agreement

Waterville Valley Recreation Department aims to provide youth programming that is inclusive and equitable to all participants. WVRD staff is trained to have a firm, fair and consistent approach to behavior management. Parents/guardians are responsible to review the Behavior & Discipline Agreement with their child(ren) to establish clear understanding of expectations and the consequences. This agreement ensures that campers, parents/guardians and staff have an established foundation of understanding before the start of our youth programs.

Stages of Behavior

Stage 1 Unsafe play; rule breaking; not following instructions 

Stage 2 Hands-on; inappropriate language; disrespect; bullying/harassment 

Stage 3 Threat to safety of self or others; physically inappropriate behavior; violence towards a camper or staff member

Please note: This is not an exclusive list. Additional behaviors may result in documentation and action steps. All behavior incidents will be documented.

Action Steps

Step 1: Verbal Warning(s) and/or Time Out 

Step 2: Removal from activity Discussion with WVRD Leadership Staff

Step 3: Call to parents from WVRD Leadership Staff 

Step 4: Parent meeting with WVRD Leadership Staff 

Step 5: Program suspension 

Step 6: Expulsion

Waterville Valley Recreation Department reserves the right to skip steps or send a child home should the situation be appropriate. No refund is given for disciplinary dismissal.

April 30, 2024

Please select who will be participating...
AdultMinor
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First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

Age: *

Emergency Medical Information

In the space below, please list any and all medical conditions and/or limitations that we should be aware of in order to accommodate the above participant's needs & ensure his/her safety. This includes, but is not limited to: allergies, behavioral issues, recent illnesses/hospitalizations, physical impairments & medications. It is best to include anything you would want an emergency medical worker to know if we have an emergency while your child(ren) are in our care. If there are none, please write "NONE" below. If more space is needed, please attach additional pages.


Allergies/Limitations (Required): *

The Waterville Valley Recreation Department encourages everyone to participate in our programs. If your child has an individualized need due to a disability and may require a reasonable accommodation, in accordance with the Americans with Disabilities Act, to successfully participate, please contact the Waterville Valley Recreation Department to discuss your child's needs.

Two weeks notice is needed to ensure appropriate accommodations can be provided.

I give permission for photos or video to be taken of my child during WVRD programs for the purpose of flyers, website, Facebook, etc (Required): (Select only one option)*
Yes
No
I give permission for photos or video to be taken of my child during WVRD programs and posted by programs and/or businesses located in Waterville Valley including, but not limited to, Waterville Valley Resort, The Rey Center, Waterville Valley Tennis Center and Waterville Valley Golf Club (Required): (Select only one option)*
Yes
No
I give permission for my child to walk or bike home alone at the end of the camp day. I understand that my child will not be permitted to leave until the scheduled end time of program, that they MUST check out with WVRD staff and that I must communicate end-of-day plans with WVRD staff each day. (Required): (Select only one option)*
Yes
No
ONLY WITH SIBLING

Town of Waterville Valley Recreation Department

About My Child Form

This form is used for informational purposes and is intended to help our staff better support your child as an individual in our programs. 


Check any applicable statements about your child and explain if necessary: 

My child has sensory challenges
My child has physical challenges
Needs assistance eating/drinking
Needs assistance changing clothes
Is uncomfortable in certain weather conditions
My child has an allergy or food restrictions
My child identifies as an alternate gender
May wander or isolate from the group
Needs assistance communicating needs

Please explain:

What would you like to tell us about your child?

Describe any concerns you or your child have regarding participation in our programs:

Does your child have a behavior management plan at school or home? Are there aspects of this plan that we can put into place during our programs that will help your child succeed?
First Participant's Signature*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Emergency Contact Information

In the event of an emergency/illness, we will first contact parent/guardian listed above. In a situation in which we cannot reach the parent/guardian, we will call the following contacts, in order, as listed below. A parent, guardian or emergency contact must be available to pick-up your child within 30 minutes. 


Name: *

Relation: *

Primary Phone: *

Secondary Phone:

Name:

Relation:

Primary Phone:

Secondary Phone:
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Age: *

Emergency Medical Information

In the space below, please list any and all medical conditions and/or limitations that we should be aware of in order to accommodate the above participant's needs & ensure his/her safety. This includes, but is not limited to: allergies, behavioral issues, recent illnesses/hospitalizations, physical impairments & medications. It is best to include anything you would want an emergency medical worker to know if we have an emergency while your child(ren) are in our care. If there are none, please write "NONE" below. If more space is needed, please attach additional pages.


Allergies/Limitations (Required): *

The Waterville Valley Recreation Department encourages everyone to participate in our programs. If your child has an individualized need due to a disability and may require a reasonable accommodation, in accordance with the Americans with Disabilities Act, to successfully participate, please contact the Waterville Valley Recreation Department to discuss your child's needs.

Two weeks notice is needed to ensure appropriate accommodations can be provided.

I give permission for photos or video to be taken of my child during WVRD programs for the purpose of flyers, website, Facebook, etc (Required): (Select only one option)*
Yes
No
I give permission for photos or video to be taken of my child during WVRD programs and posted by programs and/or businesses located in Waterville Valley including, but not limited to, Waterville Valley Resort, The Rey Center, Waterville Valley Tennis Center and Waterville Valley Golf Club (Required): (Select only one option)*
Yes
No
I give permission for my child to walk or bike home alone at the end of the camp day. I understand that my child will not be permitted to leave until the scheduled end time of program, that they MUST check out with WVRD staff and that I must communicate end-of-day plans with WVRD staff each day. (Required): (Select only one option)*
Yes
No
ONLY WITH SIBLING

Town of Waterville Valley Recreation Department

About My Child Form

This form is used for informational purposes and is intended to help our staff better support your child as an individual in our programs. 


Check any applicable statements about your child and explain if necessary: 

My child has sensory challenges
My child has physical challenges
Needs assistance eating/drinking
Needs assistance changing clothes
Is uncomfortable in certain weather conditions
My child has an allergy or food restrictions
My child identifies as an alternate gender
May wander or isolate from the group
Needs assistance communicating needs

Please explain:

What would you like to tell us about your child?

Describe any concerns you or your child have regarding participation in our programs:

Does your child have a behavior management plan at school or home? Are there aspects of this plan that we can put into place during our programs that will help your child succeed?
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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