KARE YOUTH LEAGUE SPRING CAMP REGISTRATION FORM

KARE YOUTH LEAGUE SUMMER CAMP REGISTRATION FORM

Only current KYL members may register for summer camps.
Child's Name *

First Name Last Name
KYL Member ID
Please contact the KYL Office if you need help locating your child's KYL Member ID
Child's Birthdate *

Month Day Year
Date
Address *

Street Address

Street Address Line 2

City
CAMP SESSION ATTENDING (Check One) *

Royal Friends Camp - July 8 ($55) D3 Girls Camp - July 9-10 ($90) D2 Girls Camp - July 15-17 ($130) D1 Girls Camp - July 11-15 ($210)
The Pac12 camp must now be filled out in an office because they are less than 48 hours away.
Name of Team *
KYL Leader *
Departing From: *

Irwindale Covina Upland
Returning To: *

Irwindale Covina Upland
Parent's Name *
Parent's Cell Phone *
Home Phone *
Or Other Parent/Guardian Phone
Parent's Email *

Confirmation Email example@example.com
Name of Emergency Contact *
Notify if parents cannot be reached
Emergency Contact Cell Phone *
Does the child have any Allergies? *

None Yes
(if yes, please list)
Date of last Tetanus Vaccination

Month Day Year
Explain any sickness
(subject to headaches, asthma, earaches, etc.) and/or physical limitations
Any limitations in activities?
Eating habits
What has not been covered that we should know about your child to understand and help him/her most
Can we give your child Tylenol? *

yes no
Health Insurance Company *
Policy or member number *
1. I will not allow my child to go to camp if, to the best of my knowledge, my child has, or is immediately prior to camp exposed to any communicable diseases.

2. I hereby agree to hold harmless Kare Youth League, its employees, agents and representatives and volunteer assistants for any and all problems, adverse reactions or other medical problem(s) resulting from or due to the medications, medical administration or applications given to my child. By initializing here, I agree I have read this paragraph and waive any and all rights to seek redress from Kare Youth League, its employees, agents, representatives and volunteer assistants.
Please enter your Initials Below for Item #2 *

Clear
3. I will not allow my child to bring any of the following items: radio, ipod, mp3, cell phone, electronic gizmo of any kind, knife, or snacks.

4. In case of sickness or accident, Kare Youth League has my authorization to secure such medical attention as is deemed necessary if unable to communicate with me immediately.
Signature of parent or guardian

Clear
Item Key
Member ID or Name
Amount Due

Amount Due *

USD Description

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Should be Empty:

KARE YOUTH LEAGUE SUMMER CAMP REGISTRATION FORM