Camper Information and Medical Form

Camper Information and Medical Form
Please complete one form for each camper attending GFS&T Summer Youth Camp.

Forms are due no later than May 15th.
Camper's Name:

First NameLast Name
Member Number:
Birthday:

MonthDayYear
Date
Child's age (as of June 1, 2025):
2025-2056 Grade Level:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please check all of the sessions your child will be attending:

Session 1 (June 23-27)Session 1 (June 23-27) and aftercareSession 2 (July 14-18)Session 2 (July 14-18) and aftercareSession 3 (August 4-8)Session 3 (August 4-8) and aftercare
Please check the level of swimming allowed for pool time each day:

Shallow end ONLY (up to 3.5 feet deep)Main pool ONLY (up to 6 feet deep)Whole main pool including DEEP END and DIVING BOARDNo swimming allowed
Will your child need to be pick up from swim/dive practice and escorted to camp? Please indicate your child's swim/dive participation:

Minis - pick up at 9:30am8 & Under Swim - pick up at 10:15am9-12 Swim - pick up at 9:30am8 & Under Dive - drop off at 10:45am, pick up at 11:30am9-12 Dive - pick up at 10:30amMy child will not participate in Rapids Swim or Dive team practice
MEDICAL INFORMATION
Please list all allergies:
Will your child have an emergency medical device with them (e.g., inhaler, EpiPen)?

YesNo
If yes, what kind:
Daily medications taken?
Other special dietary restrictions/requirements Camp Staff should be aware of?
Primary Care Physician Information (name and address):
Primary Care Physician Phone Number:
Please enter a valid phone number.
MEDICAL INSURANCE INFORMATION
Medical Insurance Provider:
Subscriber's Name:
Policy #:
Group #:
AUTHORIZATION & RELEASE
I hereby release Great Falls Swim & Tennis Club, Pass Academy, High Sierra Pools, Inc., officers, employees, agents, and volunteers from all liability relating to or arising out of the registrant’s participation.

The parent/guardian and member authorize immediate medical care and consent to the hospitalization, diagnostic tests, surgery, and/or medication administration to your child if an emergency occurs.

I hereby grant permission to Great Falls Swim & Tennis Club to take and use photographs, videotape, and/or digital images of my child for use in publicity, illustration, publishing (including publishing in electronic form), or other lawful uses as may be determined by GFS&T. I do this with full knowledge and consent and waive all claims for compensation for use, or damages.

I understand that refunds for camp registration fees will only be issued when written notice of cancellation and a request for a refund is received before May 15th. Between May 15th and May 31st, 50% of the full cost of registration will be refunded. No refunds will be issued after May 31st. Refund requests for Extended Day services must be submitted in writing at least one week prior to the start of each camp session. Please send all cancellation and refund requests to club@gfsandt.com.
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Camper Information and Medical Form

Please complete one form for each camper attending GFS&T Summer Youth Camp.

MEDICAL INFORMATION

MEDICAL INSURANCE INFORMATION

AUTHORIZATION & RELEASE