ESYCC 2024 Summer Camp Registration
Please complete a separate registration form for each camper
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Email *
Camper Name (First and Last) *
Preferred Name/Nickname
Date of Birth *
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Parent/Guardian *
Address: *
Phone number (Please include the area code.) *
Alternate Phone Number
For which camp(s) are you registering? *
Required
Camper's Level of Swimming Experience (please complete for Swim, Junior Sports or Sailing camps)
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Please list any Chronic Ailments, Medical Conditions & Allergies (i.e. Bee Sting Allergies, Food Allergies, ADHD, Hypoglycemia, etc.
Please list any medications that your child is currently taking.
Date of most recent tetanus shot. *
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DD
/
YYYY
Family Physician (Name and Phone Number) *
Name and Phone # of Emergency Contact #1 *
Name and Phone # of Emergency Contact #2 *
Emergency Treatment Authorization *
Required
Waiver of Liability *
Required
Photography Release *
Required
Restrictions/Comments - Please add any other information that will help our camp counselors enhance this camp experience for your child.
Member # (If applicable)
How would you like to pay for camp? *
A copy of your responses will be emailed to the address you provided.
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