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Emergency Contact Form
Thank you for participating in our camp - we look forward to working with your rower. Please fill out the form in entirety. Please email any questions to
bwhsrowing@gmail.com
.
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* Indicates required question
Email
*
Your email
Rower name (first and last)
*
Your answer
Parent/Guardian's name 1 (first and last)
*
Your answer
Best Contact Phone #1
*
Your answer
Parent/Guardian's Name 2 (first and last)
*
Your answer
Best Contact Phone # (2)
Your answer
Emergency Contact Name - not parent - (first and last)
*
Your answer
Emergency Contact #
*
Your answer
Relationship
*
Your answer
Person to whom the rower may be released (other than parent or emergency contact)
Your answer
Phone #
Your answer
Rower's Physician/Medical Care Provider
*
Your answer
Phone
*
Your answer
Health Insurance Company
*
Your answer
Phone #
*
Your answer
Health Insurance Policy #
*
Your answer
I have read, signed, and emailed in the WAIVER OF LIABILITY RELATING TO CORONAVIRUS/COVID-19 posted on the website.
*
Yes. I have emailed the signed document to
bwhsrowing@gmail.com
Required
*Please list any allergies, medications, disabilities or other special needs
Your answer
Send me a copy of my responses.
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