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Summer Camp Registration

    Camper's Name *
    DOB *
    T-Shirt Size *
    Parent/Guardian Name(s) *
    Cell Phone *
    Emergency Phone *
    Email *
    Member / Non-Member *
    Payment Method *
    Are you currently an RAC Member? (Parent must have an active membership.)
    Total Cost per Week: $225.00 (10% discount for siblings)
    Charge to Member Account.Contact me for payment information.
    Emergency Contact 1*
    Phone *
    Emergency Contact 2
    Allergies *
    Medications to be administered in case of emergency *
    Behavioral/Emotional/Physical conditions we need to know about: *
    Rollingwood Athletic Club Waiver

    I/We acknowledge, know, understand and appreciate the inherent risks of participating in health and fitness club activities at Rollingwood Athletic Club. I/We understand that strength, cardiovascular, flexibility, and other fitness activities involve strenuous, near maximum exertions; prolonged stress on the cardiovascular system; stress on the joints and ligaments; and other related risks. I/We understand the potential injuries can range from minor strains to paralysis or death. I/We hereby assert that I/We am voluntarily participating in fitness and sports activities at Rollingwood and assume the inherent risk of such participation. I/We accept full responsibility for myself and my family’s use of any and all apparatus, appliances, facility, privilege or services owned and operated by Rollingwood, at my own risk. I/We hold Rollingwood, its shareholders, directors, officers, employees, representatives and agents harmless from any loss, claim, injury, damage or liability sustained or incurred by me and my family resulting therefrom.

    Release, Waiver of Liability & Consent for Medical Treatment

    In the event of illness or injury arising out of my child’s participation in RAC Junior Tennis Program, 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

    Parent/Guardian Signature *
    Date *