ICYCC Camp Registration Form
These forms are required for a child to attend camp. An individual application must be submitted for each camper.
Camper Information
Member ID
Camper Name
*
Nickname
Age
NOTE -
Children must be 6 years old prior to selected camp date.
ICYCC Member Name:
*
ICYCC Member Number:
*
Morning Sports Camp Ages 6-10 $250 Member Rate $300 Non-Member Rate (Opens May 15, if space available)
Tennis Afternoon Camp Ages 10-17 $250 Member Rate $300 Non-Member Rate (Opens May 15, if space is available)
Golf Afternoon Camp Ages 10-17 $250 Member Rate $300 Non-Member Rate (Opens May 15, if space is available)
Sailing Camp Ages 7-17 $500 Member Rate $600 Non-Member Rate (Opens May 15, if space is available)
T-Shirt Size
Please Select
YS
YM
YL
AS
AM
AL
AXL
AXXL
Camper Swimming Ability
*
Non-Swimmer
Beginner Swimmer (can swim on front 20ft without flotation)
Advanced Swimmer (can pass swim test)
Please provide any additional information that you think is important or may affect the camper's ability to fully participate in the camp program.
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Parent Information
Parent/Guardian
Parent/Guardian
*
First Name
Last Name
Relationship to Child
*
E-mail
*
example@example.com
Cell Phone
*
Home Phone
*
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Where would you like to be reached while your child is at camp?
*
Cell Phone
Work Phone
Home Phone
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Emergency Contacts/Authorized Pickup
Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within one hour of the center/home, able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age. The first emergency contact must live no more than 1 hour away and be over the age of 18.
Full Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone Number
*
Secondary Phone Number
*
Relationship to Child
*
Name of Additional Person Authorized To Pick Up Your Camper:
First Name
Last Name
Name of Additional Person Authorized To Pick Up Your Camper:
First Name
Last Name
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Medical / Health Information
Name of Physician
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Does your child have any food, medication or environmental allergies?
*
Yes
No
Allergies? Check all that apply
*
Food
Medication
Environmental
None
Please list and explain any allergies
0/150
Does your child’s allergy/allergies require child care staff to monitor child for symptoms, take action if a reaction occurs, or give emergency medication to your child?
*
Yes
No
Does your child have a special health or medical condition?
*
Yes
No
Please explain
0/150
List any additional information about your child that would be useful for staff to know, such as fears, eating habits, or special routines. This information should not be medical or health related, as that information should be included in the previous questions.
0/200
Indian Creek Yacht & Country Club has permission to secure emergency transportation for my child in the event of an illness or injury which requires emergency treatment. The emergency transportation service will determine the facility to which my child will be transported.
*
Type first and last name above to consent
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Statement of Understanding
Sign Document
*
Date Signed
*
-
Month
-
Day
Year
Date Picker Icon
Camp Director Name and Contact Info
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SUBMIT
Should be Empty: