Week Long Youth Summer Clinics Registration Form

Week Long Youth Summer Clinics Registration Form
Parent / Guardian Information

(All correspondence and and invoices will be sent to this person)
Name*

First NameLast Name
Email*
example@example.com
Cell Phone*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Camper's Information

Personal
Name*

First NameLast Name
Birth Date*

MonthDayYear
Date
Age (at time of camp)*
School Child Attends
T-shirt Size:*

Youth SmallAdult SmaillYouth MediumAdult MediumYouth LargeAdult Large
Child's Swimming Ability*

Can not swimLearning to swimCan swim
Preferred Language for Water Activities (We are a fully bilingual camp, but for safety reasons, we will communicate with your child in the language they are most comfortable with during water activities.)*

SpanishEnglishEither
Camper's Health Information
Blood Type
List any allergies*
Significant Medical History (surgery, injuries, serious illness, etc.)*
List any Medical Problems (asthma, seizures, headaches, etc.)*
List any medication taken regularly (please note if any medication must be administered during camp)*
Emergency Contact and Authorized Pick Up
Emergency Contact (Additional to parent registering child)
Authorized Pick Up Persons (Additional to parent registering child)
Authorized Pick Up Persons (Additional to parent registering child)
Program Information

Program & Payment
Weekly Camp (9:00- 3:30 pm) $650 per week*

Week 1: June 30th- July 4thWeek 2: July 7th-July 11thWeek 3: July 14th- July 18thWeek 4: July 21st- July 25th
After Camp Care (3:30- 5:30 pm) $75 per week

Week 1: June 30th- July 4thWeek 2: July 7th-July 11thWeek 3: July 14th- July 18thWeek 4: July 21st- 25th
Total Cost
Cancellations made before 04/01/25, receive a full refund minus a $50 processing fee.
Cancellations after 04/01/25 are non-refundable, except in cases of medical emergencies (documentation required). Please be aware that we have a minimum weekly capacity to fulfill. If this capacity is not reached by 04/01/25, we will notify you and issue a full refund.
Waivers &Terms
Date

MonthDayYear
Date
Signature

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USD

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

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Week Long Youth Summer Clinics Registration Form

Parent / Guardian Information

Camper's Information

Camper's Health Information

Emergency Contact and Authorized Pick Up

Program Information

Waivers &Terms