Register for Belle Meade Swim Camp | Belle Meade B&B, Inn, Day Camp, and Farm

Belle Meade Swim Camp Registration

Price includes credit card processing fee. Limit of two sessions per camper.

Please note: our credit card processing company’s website may say that your payment is “processing…” for a very long time, possibly forever.
Please do not resubmit your form or payment in order to avoid double charges. Instead, check your email for a confirmation from us.

RM_Stats

Register 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 ^*

Country

Zip ^*

Parent/Guardian 1^*

Parent/Guardian 1 Address

Address Line 1

City

State or Region

Country

Zip

Parent/Guardian 1 Home Phone

Parent/Guardian 1 Work Phone

Parent/Guardian 1 Cell Phone

Parent/Guardian 1 Email^*

Parent/Guardian 2

Parent/Guardian 2 Address

Address Line 1

City

State or Region

Country

Zip

Parent/Guardian 2 Home Phone

Parent/Guardian 2 Work Phone

Parent/Guardian 2 Cell Phone

Parent/Guardian 2 Email

Emergency Name 1^*

Emergency Name 1 Phone^*

Emergency Name 1 Address

Address Line 1

City

State or Region

Country

Zip

Emergency Name 2

Emergency Name 2 Phone

Emergency Name 2 Address

Address Line 1

City

State or Region

Country

Zip

Physician

Physician Phone

Health Insurance

Health Insurance Policy Number

My child may use sun screen

Yes
No

Any serious illness, operation, injury?

Allergies

Medication

Family situation camp should know

Interests and hobbies

Swimming ability / experience

How 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 accept

Signature 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 accept

Signature of parent/guardian^*

Date^*

Please click or touch “Submit” only once to avoid multiple charges!^*

Select a payment method^*

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