Brimfield Antique Show

Bus Trips
All trips depart from Career High School: 100 Legion Ave., New Haven, CT 06515
*Return times are approximate.
Brimfield Antique Show
Sep 12, 2015
$45
Brimfield, MA
Depart 7:00a - Return to New Haven 7:00p*
Yankee Candle Store
Oct 10, 2015
$47
Deerfield, MA
Depart 9:00a - Return to New Haven 7:00p*
New York City (on your own)
Dec 12, 2015
$50
Depart 8:00a - Return to New Haven 9:00p*
Office—720 Edgewood Ave., New Haven, CT 06515
Website—www.cityofnewhaven.com/parks
Telephone—203.946.8020
facebook.com/newhavenparks
Registration Information
Please register for any program in person at 720 Edgewood Ave., New Haven
You may pay by cash, money orders, and MasterCard/ Visa.
Personal Checks are not accepted.
Class or Activity:
Name of Participant:
If minor:
Name of Parent:
Participant Date of Birth:
Address:
Gender:
City:
Zip:
Phone 1:
□ Home □ Cell □Work
Phone 2:
□ Home □ Cell □Work
Phone 3:
□ Home □ Cell □Work
Email Address:
Emergency Contact:
Phone:
Relationship:
Email Address:
Any health concerns or allergies which may be impacted by participation in this activity?
By signing below, you agree to support the policies of the New Haven Parks Department. You assume all risks of injury whatsoever
and agree to hold harmless, New Haven Parks Department from claims of any nature arising from any activity, including transportation, connected with New Haven Parks programs. This hold harmless agreement includes, but is not limited to, any claim for injury
proximately resulting from negligence of New Haven Parks, its employees, host sites, its sub-contractors, participating agencies and
volunteers. You further acknowledge and understand all participants in New Haven Parks and Recreation Department may be photographed or videotaped and such photos or videos may be used to publicize New Haven Parks and Recreation programs and activities.
Participants may be quoted or photographed for newspaper or magazine articles or television programs. By signing below, you hereby
grant permission for such media attention for yourself or the minor listed on this application.
Signature:
Date:
For office use only
Activity Fee:
Credit Card #:
Method of Payment:
□Credit Card
Exp:
□Money Order
□Cash
□ VISA □ MC