Camper Information
If signing up for multiple weeks only complete one form per camper. Families with multiple campers must submit one form for each child.
Camper Name
First Name
Last Name
T-Shirt size
XS
S
M
L
XL
T-Shirt range
Youth
Adult
Dates
6/22-6/26 9:00am- 3:30pm(12-18 yo) 5 Spots Left
6/29-7/2 8:450am- 3:30pm(12-18 yo) 8 Spots Left
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Date of Birth
-
Month
-
Day
Year
Date
Gender
Female
Male
Other
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Information
Emergency Contact Name
First Name
Last Name
Relationship
Emergency Phone Number
-
Area Code
Phone Number
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Medical Information
Please state if the camper have any allergies, illnesses or medical conditions.
Primary Care Physician
First Name
Last Name
Primary Care Physician Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Medical Insurance Co. and Policy Number
What Medications May Your Child Be Administered ?
Ibuprofen
Benadryl
Acetaminophen
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Waiver
The undersigned consent to furnishing to said child, medical care, attention and treatment by any hospital or physician deemed necessary or advisable.The undersigned authorize any staff of Eagle Creek Sailing Club to consent to medical care, attention or treatment of said child.The undersigned shall be responsible for all costs of such medical care, attention or treatment, and shall indemnify and hold free and harmless from any and all liability for such cost Eagle Creek Sailing Club and the staff thereof.( parent or guardian name typed above) I being fully aware of any and all dangers inherent to sailing, willingly assume the risk and do herby release ECSC (Eagle Creek Sailing Club) its Officers, directors and all others who conduct this program from any and all liability that arise . I acknowledge that I am fully aware of the inherent risks and dangers associated with sailing and related activities, including but not limited to weather conditions, water conditions, equipment failure, and physical exertion. I knowingly and willingly assume all such risks on behalf of myself and my child. In consideration of my child’s participation, I hereby release, waive, and discharge Eagle Creek Sailing Club (ECSC), its officers, directors, employees, volunteers, and agents from any and all claims, demands, actions, or causes of action arising out of or related to participation in ECSC programs, including but not limited to personal injury, property damage, or loss, except in cases of gross negligence or willful misconduct as defined by law. I further agree to pay for any boat damage in which my son/daughter is involved. In case of emergency, a supervising adult or instructor may transport my child, for any emergency treatment as determined by said hospital. By signing below you agree to have read and agree to all terms above.
First / Last Name
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My Products
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Camp Non Club Member
$475.00
$
475.00
Quantity
1
2
3
4
5
6
7
8
9
10
Camp Club Member
$400.00
$
400.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
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