Counselor In Training

Contact Information

Child's First Name *

Child's Last Name *

Child's Age *

Child's Gender

Male

Female

Guardian Name *

Guardian Email *

Phone Number *

Home Address *

City *

State *

Zip Code *

Child's Membership Status

Member

Non-Member

Payment Method

House Charge

Credit Card

Check

Cash

Registration By Week Only

Camp Dates

Consent Releases

I, being the parent/guardian of the above mentioned, agree to all field trips listed on this calendar. *

Give consent

Do not give consent

Outdoor activities are planned for your child's enjoyment during our summer camp. In order for your child to participate in these activities, this consent must be given prior to their camp session. Our outdoor activities will take place behind the club and outside of the club. Your consent is necessary for your child to participate in camp. We will be going on field trips throughout the summer to various locations in the Denver Metro area. Transportation will be provided by Horizon Coach Lines, a bus company.

I, being the parent/guardian of the above mentioned, give consent for the use of Body Eclipse SPF 30+ to be applied to my child in the event their sunscreen is left at home. *

Give consent

Do not give consent

I, being the parent/guardian of the above mentioned, give consent for the viewing of age appropriate, “G” and “PG” rated videos in the event of inclement weather. *

Give consent

Do not give consent

I, being the parent/guardian of the above mentioned, hereby consent that photographs taken by Club Greenwood may be used by Club Greenwood for Club Greenwood promotional materials, including the Club Greenwood website. I understand that these photos will be used only for promotional purposes, and will not be given to other parties for any purpose other than to promote the club. *

Give consent

Do not give consent

I may also request that Club Greenwood cease from using any particular photo in future materials or promotions, by providing written notification to the Club Greenwood General Manager or Director of Marketing. Materials that are already in existence or production at the time I provide such written notice may continue to be used until supplies are exhausted. Club Greenwood includes these photos for purposes of marketing the club, in order to showcase the club and allow members and non-members to see the variety of services and activities available at the club.

Child Release

Children will only be released to parents or guardians listed on this form and individuals whose names appear here. All individuals must present a form of identification when picking up children from the program.

Emergency Contacts

Emergency Contact Name *

Emergency Contact Phone *

Emergency Contact Email

Additional Contacts

Please enter additional names and phone numbers in the box above, as needed.

Medical Information

List any communicable diseases, serious illnesses, and/or surgeries which your child has had *

List any known drug allergies and/or drug reactions which your child has *

Describe any dietary restrictions your child must follow *

List any known food allergies *

Preferred Medical Personnel

Child's Physician *

Child's Dentist

Preferred Hospital *

I, being the parent/guardian of the above mentioned, give consent for emergency medical and/or surgical treatment in a licensed medical facility and by a licensed physician should my child’s condition require it in my absence. I understand that in such a case, reasonable attempts would first be made to contact us with time and conditions permitting. As long as the medical and/or surgical treatment considered necessary in the situation is in accordance with generally accepted standards of medical practice for the particular type of injury or illness involved. *

Give consent

Do not give consent

I impose no specific prohibitions regarding treatment unless stated here:

I confirm to Club Greenwood that my child is in good health and that his/her participation does not pose a hazard to his/her health or that of other participating campers. *

Confirm

I request that my child be admitted to Camp Greenwood. I understand that my deposit is non-refundable. Remaining balance refunds are not granted except by written request in extenuating circumstances such as relocation or hospitalization. I agree to assume full risk and to waive, relinquish and release all claims I and/or the participant may have against, indemnify, hold harmless and defend Greenwood Athletic Club Metropolitan District and JAG Management Group, LLC. This includes as well its officers, agents, all personal medical insurances and that as a participant must cover all medical costs incurred. I also understand that every precaution is taken to protect the safety of each participant. I agree to emergency treatment by a physician or hospital in the event that I or the emergency contact can not be reached.

eSignature *

I have read this release and understand all its terms and hereby execute it voluntarily with full knowledge and understanding of its significance.

Date *