2013 Sunny Days Camp Registration – Health Records & Permission
Camper Name:
Circle:
M or F
2013-14 Grade:
Birth date:
Swim experience:
Medical/Allergies:
Camper Name:
Circle:
M or F
2013-14 Grade:
Birth date:
Swim experience:
Medical/Allergies:
Camper Name:
Circle:
M or F
2013-14 Grade:
Birth date:
Swim experience:
Medical/Allergies:
*E-MAIL (Primary communication):
Home Phone:
Mother’s Name:
Circle Status:
Active Inactive
Work Phone:
Cell Phone:
Father’s Name:
Circle Status:
Active Inactive
Work Phone:
Cell Phone:
Emergency Contact:
Home Phone:
Pediatrician’s name and phone:
Cell Phone:
Select a camp or individual weeks.
Payment is due by the Monday of each week. Payable to SMCA.
Mailing Address:
June Camp
 June 5-7
 June 10-14
 June 17-21
 June 24- 28
PERSONS AUTHORIZED TO PICK UP CHILD DAILY:
July camp
 July 1-5
 July 8-12
 July 15-19
 July 22-26
August Camp
 July 29-Aug. 2
 August 5-9
Select Before/After Care if needed.
 BEFORE CARE (6-9 am)
 AFTER CARE (3-6 pm)
(Active Mother and/or Father are also authorized.)
*Indicate if there are any special
instructions on daily pick-up.
Name:
Phone:
Name:
Phone:
By signing below, I am stating that it is my desire for my child to attend the 2013 Sunny Days Summer Camp. I give permission for my child to take part in all camp activities,
including sports and camp-sponsored trips away from the camp premises, and absolve the camp from liability to me or my child because of any injury to my child at camp or during
any camp activity. In case of accident or serious illness, I understand that Sunny Days Camp may call 911 first. I request the camp to contact me. If the camp is unable to reach me, I
hereby authorize the camp to call my child’s physician and follow his/her instructions. I authorize camp administration or their designee to transport the above mentioned camper,
by ambulance or other automobile, to the nearest hospital emergency room for treatment in the event of a serious illness or injury. I understand that I am financially responsible for
costs incurred.
My child and I agree to abide by all Sunny Days regulations at all times. I understand that I am responsible for all cost/fees that apply to my child. I understand that all
payments are due prior to the start of each camp week. I hereby give permission for Sunny Days Camp to transport my child to and from all Camp related activities. I also give
permission for pictures/video of my child in a camp activity to be used for promotional material for Sunny Days Camp.
Print Name: _______________________________________
Signature: _______________________________________
Date: ________________