Poplar Beach Kids Club

Poplar Beach Kids Club

Please fill out the following form to register your child(ren) to join us this summer. Your child must be registered with the office in order to participate.
Poplar Beach Kids Club will be running in the campground gazebo on Mondays and Fridays (Alternate dates may be required due to staff availability and inclement weather.) The 2023 program is open for children ages 6-12.
Full Name

First NameLast Name
Parent/ Guardian

First NameLast Name
Lake Address

Street Address/ Campsite #
Phone Number
Please enter a valid phone number.
Email
example@example.com
Emergency Contact Information
Contact Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Relationship
Allergies/ Medical Conditions
The Poplar Beach Kids Club strives to build community and looks forward to a great summer of fun. Policies and procedures are in place with the help of our program leaders to provide a fun, inclusive, and safe environment. Failure to comply with the policies and instructions of the program leaders may result in being asked to leave and discontinue the program.
I/ We give my/our children permisison to particpate in the Resort Village of Wakaw Lake's Summer Youth Program at Poplar Beach with the understanding that there will be supervisors responsible for the child(ren) throughout every activity.

I/We acknowledge that some activities will take place on the beach near the water and that there is a risk of injury or dealth if policies are not followed. My/our children are aware that failure to follow policies and instruction will result in the loss of the ability to attend the program.

I/We acknowledge that there may be instances where my child(ren) will be required to leave during the day if policies and instructions are not being followed and I/We will pick them up upon request of the instructors.

I/We acknowledge that my child(ren) must be picked up at the specified time of dismissal.

I/We further release the Resort Village of Wakaw Lake and staff from all responsibility should any injury arise while my child(ren) are attending Poplar Beach Kids Club.
Parent/ Guardian Permission
Date of Permission

MonthDayYear
Date
Date of Birth

MonthDayYear
Date
Should be Empty:

Poplar Beach Kids Club

Emergency Contact Information