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2012 KIDS' CLUB 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)

 

Camp runs from noon-4:00PM.

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 unless camp is cancelled due to rain.

Make check payable to:

Nyack Field Club
PO Box 370
Nyack, NY 10960