Boonton Township Recreation Dept.
*Classes Held September 18th thru November 11th
At Rockaway Valley School
*4–8 years of age: Mondays & Wednesdays-6p-6:45p
*9–12 years of age: Mondays & Wednesdays-7p-8p & Saturdays-9:30a-10:30a
*13 +: Mondays & Wednesdays-8p-9:15p & Saturdays-10:30a-11:30a
**Cost is $100 + an additional $50 for “gi” - judo uniform**
Please fill out the form below and make Registration Check payable to Boonton Township Rec. Dept. and “Gi” payment to: Eric Fajardo.
Please bring payment and registration form to your first class.
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Judo Registration
Address___________________________________________________________
Phone#___________________________ Cell# __________________________
Emergency Contact____________________ Phone#_____________________
Grade _______ Birth Date__________ E-mail _______________________
Gi Size ____________ (Call the Rec. Dept. for sizing – 973-402-4001, x222)
Is your child restricted from playing sports in any way? No yes-explain
In the last 12 mos. has your child had any serious injury/illness? No yes-explain
Is your child allergic to any foods or medications? No yes-explain
I, the parent/guardian of the above named player, hereby give my approval for his/her participation in the Boonton Township Rec. Dept. Judo Program and assume all risks and hazards incidental to such participation, including medical treatment and hereby agree to waive, release, indemnify and to hold harmless the town of Boonton Township and the Boonton Township Rec. Dept. and participating schools and employees and other participants from liability, damage or claim, whether the result of negligence or other cause which may occur in the course of, prior to the start of, or after the facilitation of the above program.
Parent/Guardian Signature:_____________________________ Date________________________