Application for Summer Camp & Swim Team

Summer Youth Program | Registration

Child First Name

Child Last Name

Member #:

* Gender:

* DOB:

* Age before June 1st:

* Grade in Fall:

Address:

City:

Zip:

Parent Primary Contact Number:

Parent Secondary Contact Number:

Email Address (to receive camp information):

YOUTH PROGRAM

(Ages 5-12 | Your child must be 5 years old before the Camp Session he/she will be attending)

Please Register my child for Summer Youth Camp:

Yes

No

Please select EACH week of Summer Youth Camp your child will attend

Week 1

Week 2

Week 3

Please Register my child for Camp Plus Club:

Yes

No

Please select EACH week of Camp Plus Club your child will attend:

Week 1

Week 2

Week 3

SWIM TEAM (May & June)

(May & June | Ages 6-14)

Please register my child for Swim Team:

Yes

No

Please select your child’s age group:

Ripple (Ages 3 - 6)

Ages 5 & 6's

Ages 7 & 8’s

Ages 9 & 10’s

Ages 11 & 12’s

Ages 13 & 14’s

If your child is participating in Swim Team, please check the T-Shirt Size below:

Youth Small

Youth Medium

Youth Large

Adult Small

Adult Medium

Adult Large

My child is not participating

If my child qualifies, he/she will participate in the Invitational Championship Swim Meet:

Yes

No

N/A

Family Physician Name:

Family Physician Phone:

Hospital preference in case of emergency and you cannot be reached:

MEMBERS: I hereby apply for enrollment for my son, daughter, or grandchild(ren) in the Summer Youth Programs at Lakeside Country Club. I, or we, hereby authorize the appropriate fees for the member child or grandchild be charged to my account.In signing this application, I certify that my child/grandchild(ren) is in good physical condition and I, or we hereby agree to hold Lakeside Country Club harmless from all liability and to fully indemnify them for any claim, or claims, or damage they are caused to pay for reason of claim, or claims, by my child(ren)/grandchild(ren). Let this signing also serve as permission for my child, or children, grandchild(ren) to travel with the Lakeside Country Club Program on any outings away from the Club on a specified day to be announced.This application has my approval and consent.

Member First Name:

Member Last Name:

* Date:

* Parent’s or Grandparent’s Signature:

* Member No.: