Emergency Contact Form
In order to register For Goldens Bridge Day Camp, please:

1. Fill out this electronic form.
2. Submit the registration form.
3. Mail in a non-refundable $300 deposit to secure your space (mail to: PO Box 157, Goldens Bridge, N.Y. 10526).

You will be contacted with a confirmation email within two weeks after we receive those items.

Final payment and health forms are required by Friday, May 15th, 2020.

Tuition is non-refundable and does not include all trip fees. Please make all checks payable to Goldens Bridge Day Camp.

If you have any questions, please contact us at goldensbridgedaycamp@gmail.com.

Thank you!
Email address *
Camper name(s) *
Your answer
Mother's name, phone number, email address, & license plate number *
Your answer
Father's name, phone number, email address, & license plate number *
Your answer
Local address *
Your answer
Permanent address *
Your answer
Emergency contact #1 -- name, relationship to child, phone number, email address *
Your answer
Emergency contact #2 -- name, relationship to child, phone number, email address *
Your answer
Emergency contact #3 -- name, relationship to child, phone number, email address
Your answer
Who is the best person to contact during the camp day? *
List of people who can sign my child(ren) out from camp *
Your answer
Please note: if you wish to have your child to be signed out by someone other than those listed above, you must provide a written & signed note to the camp director.
I give permission for my family’s information to be included in the GBDC directory. *
Required
I give permission for my child’s photo to be used on the camp brochure and/or website. *
Required
Parent’s or Guardian’s Authorization: My child(ren) has/have permission to engage in all camp activities except as noted by me or the examining physician.
I give permission to the camp nurse to share my child(ren)'s health information with appropriate camp staff members, as deemed necessary. I also give permission for the information in this form to be brought on camp field trips.
In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp director to order X-rays, routine tests and treatment for the health of my child(ren). If deemed medically necessary to hospitalize my child(ren), I hereby give permission to the physician to secure proper treatment, to order injections and/or anesthesia and/or surgery for my child(ren) named above.
Please note: Goldens Bridge Day Camp reserves the right to expel any child at the camp's discretion. Deposits and tuition are non-refundable.
E-signature: please write your full name and today's date in the space below to electronically sign this form. *
Your answer
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