2021 Jr. Lifeguard Registration
Borough of Wildwood Crest
Junior Lifeguard Program
Address: Rambler Road & the Beach Wildwood Crest, NJ 08260
Phone: (609) 522-3825
Website: www.wcbp.org
First Name of Jr. Lifeguard *
Last Name of Jr. Lifeguard *
Grade *
Enter the grade your child is entering in the Fall.
Jr. Lifeguard's Date of Birth *
MM
/
DD
/
YYYY
Phone Number *
Best reached at
Summer Address *
(Street, City, State, Zip Code)
T-Shirt Size *
Emergency Contact *
Emergency Phone *
Email Address *
Medical Profile *
Will medication need to be dispensed?
Medical Profile
If yes, when?
Child's Physician *
Physician's Number *
Health & Accident Coverage
Name of Company *
Agreement # *
Parent/Guardian Authorization
I hereby waive for myself and my child the right to assert any claim against the Borough of Wildwood Crest, the Wildwood Crest Lifeguards, and any of their agents, servants, or employees arising out of injury to the child due to participation in, preparation for, or travel to and from any recreation program or activity authorized by the Wildwood Crest Lifeguards. I relinquish any right that I or my child might otherwise have for payments of medical costs or other losses beyond whatever Insurance I have. I hereby authorize the director, staff, and volunteers of the Wildwood Crest Lifeguards to act for me according to their best judgement in any emergency requiring medical attention. I also authorize the Wildwood Crest Lifeguard Department to use pictures/images of my child for Program promotions. *
Parental Name
By entering your initials in the box below, you are effectively providing your signature, indicating that you agree to the authorization and all the information on this form is true and accurate, to the best of your knowledge. *
Registration fee: $50.00
Payment due at start of camp.

Make checks payable to: Borough of Wildwood Crest.

***PLEASE INCLUDE CHILD'S NAME IN CHECK MEMO
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