MBC2 Camp Registration Form 2019

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Email *

Child's Name *

Please complete ONE registration for EACH child

Child's Date of Birth *

YYYY

Weeks enrolled *

Week 1 (6/25-6/29) - $400

Week 2 (8/6-8/10) - $400

Both weeks - $750

Sailing Ability Level *

Beginner - has never sailed or is not yet sailing independently

Intermediate - can sail a reach independently and get in and out of safety position

Advanced - Can sail all points of sail (upwind, reaching, running) and learning to race

Racer - has sailed in multiple regattas

Not sure

Tennis Ability Level *

Beginner

Intermediate (can hit forehand, backhand, volley - learning to serve and hit overheads)

Advanced (can hit all strokes, learning match play)

Match Play - On the Tennis Team

Not sure

Can your child swim? *

Yes - passed the raft test last year

Lifejacket - can swim to the raft, but needs a lifejacket

Does your child have any medical conditions or allergies? *

Peanut allergy

Gluten allergy/sensitivity

Bee Sting allergy

Diabetes

History of concussions

None

Other:

Required

Emergency Medication Policy Acknowledgement *

If your child requires emergency medication (i.e.EpiPen or inhaler), the medication must be put in a ziplock bag labeled with your child’s name and your emergency contact number and dropped off with the Waterfront Director before the first day of camp. By initialing this document I understand and agree to this policy.

Parent's (or guardian)'s Name *

Parent's (or guardian's) Cell Phone Number *

Emergency Contact Person & Relationship to child *

Emergency Contact Person Cell Phone Number *

Name of MBC Member responsible for Payment *

MBC requires that an MBC member provide payment for camp. MBC will invoice the designated member (either the child's parent/guardian or grandparent if the child's parents are not members of MBC) for the applicable registration fee at the beginning of the camp session.

Waiver *

I, the Parent/Guardian of the Child named above (“Child”) and hereby acknowledge that the execution of this Agreement is a condition to the participation of Child in the MBC Camp hereinafter referred to as the “Camp”) as stated above. I accept that the sports of sailing, swimming, and tennis included in the above camp entail and are subject to certain inherent risks, and, on behalf of Child, accepts all risks on land and at sea of participation in the Camp. Now, therefore, I do hereby agree as follows: 1) I consent to the participation of Child in Camp. 2) I (including heirs, successors and assigns) waive any claims against and releases any obligation of the Madison Beach Club (the “Club”), its employees, agents and or any other person acting in any capacity for the conduct of the camp in relation to any loss, injury or damage, on land or at sea, to Child or property of mine to the fullest extent permitted by law. 3) I hereby authorize an instructor from the Club or Program, or an adult who bears this document, to authorize emergency treatment for the Child named above in the event that a parent or legal guardian cannot be reached at the above telephone numbers at the time of the emergency. 4) I hereby grant to the Club the right to use my child’s name, age, and photograph, without compensation, in any press release, web site posting, advertisement, brochure or other medium intended to publicize the Camp or other Club activities. I have thoroughly read and understand the 2019 Waiver Agreement. By initialing this document, I acknowledge the execution of this agreement and agree to each of the provisions listed above.

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms