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2012 SUMMER CAMP REGISTRATION FORM:

* Child's Name:
* Date of Birth:
* Grade In Sept:
Swim Team Member:(Y/N)
Team A or B:
* Parent's Name:
* Address:
City: State: Zip:
Phone (H):
Phone (W):
Cell Phone:
Emergency Contact:
Emergency Phone:
Significant Medical History:
Allergies:
* E-mail:
Check mark the time your would like to attend :













Registration Fees:
3 days (M, W, F)
5 days (M- F)

"A" SWIM TEAM MEMBERS
3 days (M, W, F)
5 days (M- F)

Camp runs from 9:00AM-12:00N. Select your weeks and the 3-day or 5-day option. Please submit a separate form per child.

 

IMPORTANT: A $100 LATE FEE PER CHILD WILL BE ADDED TO ALL REGISTRATIONS NOT SUBMITTED AND PAID BY April 15th.  

NO REFUNDS WILL BE GIVEN

Make check payable to:

Nyack Field Club
PO Box 370
Nyack, NY 10960