Please fillout the form completely. One of our team members will contact you for credit card information. Class Schedule

Child Info
Child's Name
Age
Sex
Date of Birth
(mm/dd/year)
Contact Info
Home Phone
Address
City
State
Zip
Email

Parent(s) or Guardian(s):

Father
Mother
Emergancy Info
Allergies or limitations pertinent to camp participation:
In case of emergency - Please contact:
Name
Phone
Child's Doctor's Information:
Name
Phone
Week #1
Session#
Dates: From
To
AM (9-12) Class
Cost $
PM (1-4) Class
Cost $
Week #2
Session#
Dates: From
To
AM (9-12) Class
Cost $
PM (1-4) Class
Cost $
Early/Extended Care
Early / Extended car is $20 per AM or PM Session
  MON TUE WED THURS FRI TOTAL
Early Care (8:00 - 9:00am)
Extended Care (4:00 - 6:00am)
 
Camp T-Shirt (PRE ORDER)
Child(S-L) $12 (Regular $15)
TOTAL
Size
Number Ordered
Adult(S-XL) $15 (Regular $18)
Size
Number Ordered
Payment Information

Authorization
I have read and agree with the terms below
I herby authorize the staff of the Mission Bay Sportcenter to act for me according to their best judgement in any emergency requiring medical attention, and I hereby waibe and release Mission Bay Sportcenter, Inc., It's officers, employees and agents from any and all liability for any injuries or illnesses incurred while attending programs at Mission Bay Sportcenter. I have no knowledge of any physical impairment that would be affected by the above named camper's participation in the summer program, as outlined in the brochure. I also understand that Mission Bay Sportcenter retains the right to use for publicity and advertising purposes photographs taken during the summer program. A medical history form, clothing and supplies list and registration confirmation will be sent upon receipt of registration form and payment.
Full Name
Date

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