Winter Break Sports Camp 2018 Registration
For ages 6-11
December 19 - December 28
Half day, full day, and weekly rates available
Parent's Name: *
Your answer
Parent Contact Number: *
Your answer
Parent Email: *
Your answer
Child's Name: *
Your answer
Is camper an active Valley member? *
If camper is not an active Valley member, please register in person (additional fees apply)
My child is authorized to charge to my Valley account:
Child's Age: *
Your answer
Address: *
Your answer
Emergency Contact: *
Your answer
Emergency Contact Phone: *
Your answer
Adult(s) authorized to pick up child: *
Your answer
Medical Insurance: *
Your answer
Insurance Number: *
Your answer
If I cannot be reached and the camp authorities have followed the company's medical procedure, I agree to assume all costs for transporting and medically treating the above-named child. I also hereby consent to any treatment, diagnostic procedure, or administration of anesthesia as may be deemed necessary. *
Required
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