Camp Registration

Last Name of Family

Address

Phone

(###)

###

####

Name of Camper #1

First Name

Last Name

Birthdate of Camper #1

YYYY

Age of Camper #1 as of 7/1/21

Message

Please describe any physical, behavioral, emotional, learning, medical challenges, diet restrictions, and/or allergies your child/children may have. or any other pertinent information that you feel Pascack Valley Swim Club should know about that may affect ability to fully participate in camp. Attach additional information as needed.

SUNSCREEN PERMISSION: I give Pascack Valley Swim Club staff permission to apply sunscreen as needed.

Yes

Type of sunscreen provided by family

Name of Camper #2

First Name

Last Name

Birthdate of Camper #2

YYYY

Age of Camper #2 as of 7/1/21

Name of Camper #3

First Name

Last Name

Birthdate of Camper #3

YYYY

Age of Camper #3 as of 7/1/21

Parent/Legal Guardian Name

First Name

Last Name

Address if different from camper's

Relationship to camper

Best number to contact during camp hours

(###)

###

####

Alternate phone number to call during camp hours

(###)

###

####

Emergency Contact #1

First Name

Last Name

Emergency Contact #1's Relationship to camper

Emergency Contact Phone Number

(###)

###

####

Does your child have any underlying medical conditions that you feel we should be aware of? *All information will be kept confidential