Athletic Club of Bend | Youth Programs
This form needs to be completed before you can register your child for youth programs (childcare, camps, parents night out, etc) at Athletic Club of Bend.

In addition to completing this form, you will also need to sign our online waiver at:
https://www.webwaiver.com/sign/athleticclubofbend/youthprograms

Once BOTH of these items have been completed, please email youth@athleticclubofbend.com to request that your child be added to the roster for any programs you're interested in. If there is a spot available, we will send you a confirmation email. Otherwise we'll notify you that your child is wait-listed.

For questions, concerns, or additional information:
Contact Ian Inman at (541) 385-3062
Email: ian@athleticclubofbend.com
Visit Us: 61615 Athletic Club Dr, Bend, OR 97702

Email address *
Parent/Guardian #1: First and Last Name *
Your answer
Parent/Guardian #1: Phone Number *
Your answer
Parent/Guardian #2: First and Last Name
Your answer
Parent/Guardian #2: Phone Number
Your answer
Home Address (Street, City, State) *
Your answer
Emergency Contact: First and Last Name *
Your answer
Emergency Contact: Phone Number *
Your answer
Is anyone authorized to pick up your child other than a parent/guardian? *
If you answered "yes" above, please provide the first and last name of anyone authorized to pick up your child.
Your answer
Child: First and Last Name *
Your answer
Child: Date of Birth *
MM
/
DD
/
YYYY
Child: Gender *
Does your child have any medical conditions, food sensitivities, behavioral challenges, or special needs? If so, please provide us with this information:
Your answer
Will your child have any medications or medical devices with them while attending our programs? If so, please provide us with this information:
Your answer
Describe your child's swimming ability (if they will be participating in camps)
Are you an employee at ACB?
Anything else we should know?
Your answer
A copy of your responses will be emailed to the address you provided.
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