2020 Summer Program for 6th, 7th and 8th graders - Registration Form
Program admission is Rolling - Priority Registration Deadline is March 30, 2020

Program runs Monday - Friday from 9am-3pm and will include environmental science, rowing and sailing. Participants will be provided with daily lunch and snack, as well as a camp t-shirt and water bottle. All staff are first aid and CPR certified.

Please contact Sarah Miles, Director of Public Programs with any questions at sarah@rockingtheboat.org OR 718-466-5799 x1229.
What Session are you registering for?
PARTICIPANT INFORMATION
Please provide information about the registrant
Child's Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Grade in September 2019
Your answer
School Name
Your answer
Current Mailing Address
Your answer
T-Shirt Size (for camp shirt)
PARENT/GUARDIAN INFORMATION
Please provide contact information for the parent/guardian of the child participant
Name of Parent/ Guardian Registering Child
Your answer
Email
Your answer
Phone Number (primary)
Your answer
Phone Number (additional if available)
Your answer
Name of 2nd Parent/Guardian
Your answer
2nd Parent/Guardian Email
Your answer
2nd Parent/Guardian Phone Number (primary)
Your answer
2nd Parent/Guardian Phone Number (additional is available)
Your answer
EMERGENCY CONTACT INFORMATION
Please provide additional contact information in the event that parent/guardian is not available
Contact Name
Your answer
Contact's Relationship to Child
Your answer
Phone Number
Your answer
Additional Phone Number (if available)
Your answer
Contact #2 Name
Your answer
Contact #2 Relationship to Child
Your answer
Contact #2 Phone Number
Your answer
Contact #2 Additional Phone Number (if available)
Your answer
HEALTH BACKGROUND
Please share necessary health information
Please list any Allergies (write N/A if there are none)
Your answer
Please share any physical restrictions while attending program (write N/A if there are none)
Your answer
Please share any food or dietary restrictions (write N/A if there are none)
Your answer
Please name any medication (write N/A if there are none)
Your answer
If child is taking medication, will they be bringing it to program with them?
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