Belle Meade Swim Camp Registration Price includes credit card processing fee. Limit of two sessions per camper. RM_StatsRegister for *×Session(s) desired * June 12-16 June 26-30 Name of Camper(s) *Age(s) *Birth Date(s) *Entering Grade(s)Address Address Line 1 * City * State or Region Alabama Alaska Arizona Arkansas Armed Forces America Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State or Region * Country Zip * Parent/Guardian 1 *Parent/Guardian 1 Address Address Line 1 City State or Region Alabama Alaska Arizona Arkansas Armed Forces America Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State or Region Country Zip Parent/Guardian 1 Home PhoneParent/Guardian 1 Work PhoneParent/Guardian 1 Cell PhoneParent/Guardian 1 Email *Parent/Guardian 2Parent/Guardian 2 Address Address Line 1 City State or Region Alabama Alaska Arizona Arkansas Armed Forces America Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State or Region Country Zip Parent/Guardian 2 Home PhoneParent/Guardian 2 Work PhoneParent/Guardian 2 Cell PhoneParent/Guardian 2 EmailEmergency Name 1 *Emergency Name 1 Phone *Emergency Name 1 Address Address Line 1 City State or Region Alabama Alaska Arizona Arkansas Armed Forces America Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State or Region Country Zip Emergency Name 2Emergency Name 2 PhoneEmergency Name 2 Address Address Line 1 City State or Region Alabama Alaska Arizona Arkansas Armed Forces America Armed Forces Europe Armed Forces Pacific California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State or Region Country Zip PhysicianPhysician PhoneHealth InsuranceHealth Insurance Policy NumberMy child may use sun screen Yes No Any serious illness, operation, injury?AllergiesMedicationFamily situation camp should knowInterests and hobbiesSwimming ability / experienceHow did you hear about Belle Meade Swim Camp?Emergency medical release *I give permission for Belle Meade Camp staff to obtain medical treatment for my child at my expense in the event of injury or sudden illness. If my child needs to be transported to an emergency facility, that decision will be made by the emergency team which responds to the call. The emergency medical team and the treatment facility have my authorization to provide treatment which a physician deems necessary for the well being of my child. I give permission for the camp staff to administer emergency medical attention to my child until I can be contacted.I acceptSignature of parent/guardian *Date *Permission / Waiver *My child has my permission to participate in the swimming program and to go on hikes and excursions. I assume all risks associated with my child’s participation in Belle Meade Camp. I understand that reasonable precautions will be taken for my child’s safety. I release Belle Meade owners and staff from all responsibility for accidents or personal injury.I acceptSignature of parent/guardian *Date *Please click or touch “Submit” only once to avoid multiple charges! *Select an optionI will only submit this form onceSelect a payment method * Note: It looks like JavaScript is disabled in your browser. Some elements of this form may require JavaScript to work properly. If you have trouble submitting the form, try enabling JavaScript momentarily and resubmit. JavaScript settings are usually found in Browser Settings or Browser Developer menu.
