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:
Once BOTH of these items have been completed, please email
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
Visit Us: 61615 Athletic Club Dr, Bend, OR 97702
Parent/Guardian #1: First and Last Name
Parent/Guardian #1: Phone Number
Parent/Guardian #2: First and Last Name
Parent/Guardian #2: Phone Number
Home Address (Street, City, State)
Emergency Contact: First and Last Name
Emergency Contact: Phone Number
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.
Child: First and Last Name
Child: Date of Birth
Prefer not to say
Does your child have any medical conditions, food sensitivities, behavioral challenges, or special needs? If so, please provide us with this information:
Will your child have any medications or medical devices with them while attending our programs? If so, please provide us with this information:
Describe your child's swimming ability (if they will be participating in camps)
Never been in a pool before
OK to swim WITH a life vest or PFD (personal flotation device)
OK to swim WITHOUT a life vest or PFD (personal flotation device)
Are you an employee at ACB?
Anything else we should know?
A copy of your responses will be emailed to the address you provided.
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