Forms

Health History Form

We have replaced our traditional health history form with ePACT Network for better safety and no more paper forms! ePACT is a secure emergency network, that we will use to collect medical and emergency contact information electronically.

How it works:
  1. After you’ve registered your child for Adventure Camp, Hidden Meadows Day Camp, Summer Recreation Program or Winter Woods Day Camp, you’ll receive an email invitation to share information with Centerville-Washington Park District.
  2. Click ‘Complete Request’ to create a free account, or log-in if you already have an existing ePACT account.
  3. Enter the required information, like medical conditions, and share it with Centerville-Washington Park District.
  4.  You can update your information at any time in the year, and we will automatically be notified (e.g. a new cell phone number)!

ePACT makes it easier for you to share emergency information with us, while also ensuring we have access to records anytime, anywhere. You own your account and the information in it. Plus, ePACT maintains the same levels of security as online banking and limits access only to the administrators we assign for enhanced privacy.

 

You will need Adobe Reader to view the following files:

Epi-pen Document Packet (PDF) >

In order to provide the best possible care for your child, while  attending our programs, the Centerville-Washington Park District has adopted a policy for the administration of Epinephrine for children with severe allergies. All information must be completed and returned to the Park District at least one week prior to your child attending camp or the Summer Recreation Program.

Commercial Filming/Photography Request (PDF) >

No person or company may use the parks for commercial photography purposes without the specific written permit of the Centerville-Washington Park District. Once granted, the permit is nontransferable and must be in the representative’s possession while on park property.

Sprayground Group Visit Request (PDF) >

Plan a visit to the Activity Center Park sprayground with your group or daycare. Read the information, print the request form and submit the completed form to the Park District. This form does not reserve the park shelter.

Athletic Release – 4 per page (PDF) >

Release form for participants in athletic organizations using Park District facilities.

Athletic Release (MS Word) >

Release form that can be copied into your document for participants in athletic organizations using Park District facilities.

General Release – 4 per page (PDF) >

Release form for participants in Park District programs and events.

General Release (MS Word) >

Release form that can be copied into your document for participants in Park District programs and events.