Somerville Recreation Logo
SOMERVILLE RECREATION REGISTRATION FORM 2026
Program Name
Fee
Please print and return to: Somerville Recreation, 25 West End Avenue, Somerville, NJ 08876.
Checks should be payable to Somerville Recreation.
Registrations are also accepted at: https://register.communitypass.net/somerville
PARTICIPANT
M
F
DATE OF BIRTH
GRADE
SCHOOL
SHIRT SIZE (If applicable)
YS
YM
YL
AS
AM
AL
AXL
PARENT/GUARDIAN NAME
EMAIL (REQUIRED)
ADDRESS
PRIMARY PHONE
ALT PHONE
EMERGENCY CONTACT INFORMATION
PRIMARY CONTACT NAME
RELATIONSHIP
PHONE #
SECONDARY CONTACT NAME
RELATIONSHIP
PHONE #
MEDICAL CONDITIONS COACHES or INSTRUCTORS SHOULD KNOW ABOUT:
Please note the Borough and its employees or volunteers will not dispense any medication, prescribed or over the counter or administer the EPI pen.
If the participant has individualized needs due to a disability, please check the following and someone will contact you regarding reasonable modifications.
Yes, I will need to be contacted regarding reasonable modifications for my child and I have provided the necessary three (3) weeks notice prior to the beginning of the program(s).
PHOTO CONSENT: From time to time the Somerville Recreation Department will feature its programs in the local newspaper, Somerville Recreation Facebook Page, and the Borough of Somerville Website. While the intent of this practice is to be informational, we respect the individual’s right to privacy. To provide parents and participants with the option to exercise their right to privacy, the Somerville Recreation department is providing the opportunity to have individual names and pictures removed from all lists and publications. I hereby grant permission for myself and/or child as parent/guardian and on behalf of any other named person in this application, hereby authorize and consent to the use of his/her visual image by the Borough of Somerville and the Borough of Somerville Recreation Department for appropriate purposes, including but not limited to still photography, videotape, electronic and print publications and websites. I give this consent with no claim for payment.
Please check here if you DO NOT consent to the photo release
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