Fall Camper Information

Name*

Age*

Email*

Emergency Contact and Safety Information

Please list at least one emergency contact.

Does your child have known allergies?*

Yes
No

If yes, please describe

Does your child have any heath concerns (Medications, Chronic conditions, behavioral or mental disabilities) we should be aware of to facilitate safe and successful participation?*

Yes
No

If yes, please describe

Authorized Pick up:

If anyone other than a parent or legal guardian is picking up a child, a pick-up authorization form must be completed with the camp instructor. If the person authorized to pick up your child is not a member, a guest pass will be issued and left at the Athletic Entrance for them to pick up upon entry to the Club.

Please check the applicable days

Select All
Monday
Tuesday
Wednesday
Thursday
Friday

Authorized Individuals

Upon pick up, the following individuals are authorized to pick up my child. Please note, an ID will be required to release a child to someone other than a parent or legal guardian.

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