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Junior Program Registration

    Participant’s Name *
    DOB: *
    Parent/Guardian Name(s) *
    Phone *
    Email *
    Parent/Guardian Name(s) *
    Phone *
    Email *
    Address *
    City *
    State *
    Zip *
    Age

    7-1011-1314 & Up

    Program

    AquaticsFitness

    Time

    SeptemberOctoberNovember

    Payment Method

    Charge to RAC Member AccountContact me for payment information

    *Your reservation is not complete until payment has been made. You can contact us at (916) 988-1727

    Emergency Contact *
    Phone *
    Emergency Contact
    Phone
    Allergies
    Medications to be administered in case of emergency
    Behavioral/Emotional/Physical conditions we need to know about
    Release, Waiver of Liability & Consent for Medical Treatment

    In the event of illness or injury arising out of my child’s participation in RAC Summer Camp, I give consent and authorization for (1) the administration of emergency first aid care and treatment at the scene of an emergency by employee at RAC, or (2) the administration of any treatment deemed necessary by a licensed physician, and (3) the transfer to a hospital reasonably accessible.

    By signing and initialing below, I agree to the following terms and conditions

    all agreements must be checked

    Child(ren)'s Name *
    Parent/Guardian Signature *
    Date *