Camp & Event Registration - Columbia Athletic Clubs

Participant Information

Participant Name*

First Last

Date of Birth*

Age

Participant is a:*

Do we have your permission to use your childs photo/video for Columbia Athletic Club Silver Lake?*

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 Name*

First Last

Email*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Emergency Contact Person*

Emergency Contact Phone*

Comments

If you require early drop off or late pick up please let our Programs Director, Natalia, know upon scheduling camps.

Payment must be received at time of registration.

A refund/credit will be granted if the withdrawal or cancellation request is received at least 30 days prior to camp. At least 14 days notice will result in a 50% refund.

Payment must be received at time of registration. Price will be determined based on membership status at the time of enrollment.

I understand that my enrollment is not complete and my child’s spot is not saved until payment is collected.

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.

Name

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