Registration

choose site: Los Altos__________ Homestead_________

Instructions: Print and complete this page, or download a PDF version of this form

Camper Information

Name of Camper #1:
 
Name of Camper #2:
 
Grade and Age, 2007-08:
Grade:        Age:
Grade and Age, 2007-08:
Grade:        Age:
Address:
 
Shirt Size (circle):
 YS    YM    YL    YXL 
 
 
 
 AS    AM    AL    AXL
City, State, ZIP:
 
Name of Camper #3:
 
Home Phone:
 
Grade and Age, 2007-08:
 Grade:        Age:
Shirt Size (circle):
YS    YM    YL    YXL
Shirt Size (circle):
 YS    YM    YL    YXL
   AS    AM    AL    AXL
 
 AS    AM    AL    AXL

Parent Information

Father’s Name:
 
Work Phone:
 
Cell Phone:
 
Employer:
 
e-mail:
      
 
 
 
 
Mother’s Name:
 
Work Phone:
 
Cell Phone:
 
Employer:
 
e-mail:
      

Emergency Contact Information (other than parents)

Name:
 
Phone:
 
Doctor:
 
Phone:
 
Name
 
Phone:
 
Dentist:
 
Phone:
 

Please indicate week(s), as well as any extended care hours that you are registering for:

Week   9:30 - 4:30   Extended Care Hours
June 16 – June 20         a.m.   p.m.
June 23– June 27         a.m.   p.m.
June 30 – July 3 *         a.m.   p.m.
July 7 – July 11         a.m.   p.m.
July 14– July 18         a.m.   p.m.
July 21– July 25         a.m.   p.m.

July 21 - July 25 Half Day Program available upon special request - contact Monica Lodge at 650-298-9740 or monica_lodge@sbcglobal.net

* Golden Eagle Sports Camp will be closed July 4 th

* Please sign the waiver on back and indicate children's t-shirt size.

Please circle one: 
returning camper_____, or, rererred by (name of newspaper)________________,
web-site______, word of mouth______, other__________.

WAIVER OF LIABILITY AND DISCLAIMER

To induce the Golden Eagle Sports Camp to accept registration and permit participation in Golden Eagle Sports Camp by the named individual(s), we, the parents or guardians of said individual(s), hereby give our consent and agree to release and hold harmless Mountain View-Los Altos UHSD, Fremont UHSD, Golden Eagle Sports Camp and its coaches from any claim arising out of injury to named individual(s). We also give permission to obtain available medical treatment in case the parent ./guardian cannot be reached.

Legal Authorization for Emergency Care and acknowledgment of Disclaimer:

Name of participants: __________________________________________________________

 

Signature of Parent/Guardian_________________________    Date :_________________

 

 

Please make checks payable to:

Golden Eagle Sports Camp
P.O. Box 896
Los Altos, CA 94022
650-298-9740
www.goldeneaglecamp.org

Employee ID Number: 77-0287218