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) $600 per week*

Week 1: June 22nd- June 26thWeek 2: June 29th-July 3rd
Calculation
Payment link will be sent to the email you have provided above. We will send links once the enrollment is approved.

Cancellations made before 04/01/26, receive a full refund minus a $50 processing fee.
Cancellations after 04/01/26 are non-refundable, except in cases of medical emergencies (documentation required).
Waivers &Terms
Date

MonthDayYear
Date
Signature

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Are you interested in sponsoring a child for a week of summer camp? Your tax-deductible donation provides scholarships to families who do not have the financial resources to send their children.

If so, please indicate the amount you would like to contribute below.$
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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