First Name:      
Last Name: 
Email address: 

Street Address: 
City:      State:      Zip: 
Telephone: 

Date of Birth:   Age(at camp):   
Sex:    Male   Female

Roommate Request: 

T-shirt Size: 
                        
  
Parents or Guardians:
  Name: 
  Telephone (daytime): 
                   (evening): 
  Parent's email address: 

 *** THE WAIVER FORM BELOW MUST BE COMPLETED BY THE PARENT/LEGAL GUARDIAN OF THE APPLICANT***

MEDICAL TREATMENT AUTHORIZATION

I/We being the legal guardian(s) of the above applicant, authorize the Navy Swimming Camp and its agents permission to request medical treatment as necessary to insure the well being of the applicant.
I am the parent/legal guardian of the applicant and agree to the Medical Treatment Authorization terms

I am the parent/legal guardian of the applicant and do NOT agree to the Medical Treatment Authorization terms  (application cannot be accepted)

INSURANCE

Coverage for accidental injury is required by all participants. Please email/mail/fax in a copy your current Insurance Card/Information. If, for any reason we need to take your child to the hospital, this will help streamline the administrative process. Please complete the health care information below:
HEALTH INSURANCE CARRIER:
POLICY NUMBER:

WAIVER

I approve of my child’s attendance at the Navy Swimming Camp and certify that he/she is in good health and able to participate in the program activities. I am  am not attaching a statement explaining special physical limitations and/or required medication. Please indicate if your child suffers from allergies, asthma, diabetes, restricted activities, etc. In further consideration of the Navy Swimming Camp accepting this application, I/we hereby agree to save and indemnify and keep harmless the Navy Swimming Camp, its agents, and employees against any and all liability, claims, judgments or demands for damages arising as a result of injuries sustained by the applicant during or as a result of any course given the applicant of the Navy Swimming Camp.
  I am the parent/legal guardian of the applicant and agree to the above Waiver terms

I am the parent/legal guardian of the applicant and do NOT agree to the above Waiver terms  (application cannot be accepted)

 Optional Health Statement: