(*) denotes required information.
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| A $100 deposit must be received by the swimming camp office in order for this registration to be activated. |
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| Camper Information: |
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| * First Name: |
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| * Last Name: |
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| * Gender: |
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| * Address: |
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| * City: |
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| * State: |
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| * Zip: |
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| * Home Phone: |
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| Business Phone: |
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| School/Club Team Name: |
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| * Date of Birth: |
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| * Adult T-shirt Size: |
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Small
Medium
Large
X-Large
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| Roommate Request: |
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| Please make sure that all parties involved are in agreement. |
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| Emergency Contacts: |
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| * Primary Contact: |
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| * Phone: |
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| Secondary Contact: |
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| Phone: |
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| Camp Selection: |
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| * Check your choice: |
One-week overnight camp ($430 per person)
Day-camp only ($390 per person)
Additional family member ($390 for additional person)
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| Waiver Statement: |
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| All campers must have their own medical coverage. The camp provides only excess coverage after your insurance policy has been utilized. Campers will not be allowed to participate unless the following information is submitted and the form is signed by the parent or guardian of the camper. |
| * Camper's Insurance Company: |
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| * Policy Number: |
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| I, the undersigned, hereby certify that I am the parent or legal guardian of the camper. I hereby give permission for the staff of the Camp to seek during the period of the Camp appropriate medical attention for the camper and for the medical attention to be given and for the camper to receive medical attention in the event of accident, injury, or illness. I will be responsible for any and all costs of medical coverage policy. |
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| I, the undersigned, for ourselves, our heirs, executors, and administrators, waive, release, and forever discharge the Gettysburg College and the Camp, and its staff, officers, agents, employees, representatives, successors, and assign of and from all rights and claims for damages, injury, or loss to person or property which may be sustained or occur during participation in Camp activities or while at Camp. |
| * Signature: |
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| * Date: |
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| Doctor's Permission: |
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| Every camper must have had a physical as of August 1, 2007, and a physician must certify that the camper listed on the registration form is qualified to attend. |
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| A note from a physician may be used and sent at a later date or brought to registration. No camper will be allowed to participate without a doctor's permission. |
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300 North Washington Street · Gettysburg, PA 17325