Type Full Name :
Sign With Hand
Type Full Name :
Sign With Hand
Email *
Cell Number
Activity or Trip Name/Description
First Name *
City *
Daytime Phone Number *
Evening Phone Number *
State *
Work Phone
City of
Trenton
State *
City *
Parent/Guardian Information
Child Information
Coordinating Recreation Center
Last Name *
By signing below, I, as the parent/guardian of the above-named child, hereby give permission for the above-named child or (myself) to 
participate in programs and activities offered by the City's Department of Recreation, Natural Resources and Culture.  Also, I give permission
for me and/or my child's image/name to be used in the City of Trenton public relation materials.
Please list any medical concerns/allergies, enter "None" if not applicable *
Division of Recreation
319 East State St., 1st Floor
Trenton, New Jersey 08608
(609) 989-3628
www.trentonnj.org
Zip *
Daytime Phone Number *
Are you the legal guardian? *
Last Name *
Date of Birth *
WAIVER OF LIABILITY
I hereby waive, release, indemnify and hold harmless the City of Trenton and The Department of Recreation, Natural Resources & Culture,
its staff, volunteers and persons transporting my child (myself) to or from the above-named program from any claim arising out of injury
to my child or (myself).
Permission Form
Address *
First Name *
First Name *
Home Phone *
Evening Phone Number *
Zip *
Home Address *
Address *
Grade *
Date of Activity
Parent/Guardian Signature *
Emergency Contact Information
Last Name *
Waiver Signature *
State *
Permission and Liability Waiver
Relationship to child *
City *
Activity Information
Does this child live with you? *
Zip *
Age