Pine Lake Camp & Event Registration

Submit registration request form for each Child. Use Comment box at bottom of form for any questions, restrictions or special requests. Once your form is received you will get confirmation of being received within 24hrs.

Registration is Online or in-person, but must be received at least 24 hours in advance.

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Participant Information

Participant Name*

First Last

Date of Birth*

Age

Participant is a:*

Member

Non-member

Reservation Request For

Camps / Events / Activities 1

Camps / Events / Activities 2

Camps / Events / Activities 3

Camps / Events / Activities 4

Camps / Events / Activities 5

Camps / Events / Activities 6

Contact Information

Contact Name*

First Last

Email*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Emergency Contact Person*

Emergency Contact Phone*

Comments

Refund Policy

A refund/credit will be granted if the withdrawal or cancellation request is received at least 1 week prior to camp. No refund/credit will be granted with less than 1 week notice.

Payment must be received at time of registration.

I understand that this is a registration request form and my enrollment is not complete.

I accept full responsibility for my child’s use of any and all apparatus, appliances or facility privilege or service whatsoever, owned and operated by Columbia Athletic Clubs at their own risk and shall hold the Club, its shareholders, directors, officers, employees, representatives, and agents harmless from any and all loss, claim, injury damage or liability sustained or incurred by my child resulting therefrom.