Huntersville Family Fitness & Aquatics


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Are you a HFFA member? Yes_____ No_____ KeyTag#__________________ Child's Name:______________________________________________________________________________________ Date of Birth:_____/____/_______ Age ____________ Rising grade ______________ Mother's Name: ____________________________________________________________________________________ Email:___________________________________________________________ Address_______________________________________________________________________ City:____________________________________________State:_________________________Zip:__________________ Home Phone:_____/_____/ ______Cell Phone:_____/_____/ ________Work Phone:_____/_____/ ______ Father's Name: _____________________________________________________________________________________ Email:____________________________________________________________ Home Phone:_____/_____/ ______Cell Phone:_____/_____/ ________Work Phone:_____/_____/ ______ Does your child have any allergies? ___Yes ____No If yes, what? _______________________________________________________________________________________ ____________________________________________________________________________________________________ Please list any other medical conditions: ____________________________________________________________ ____________________________________________________________________________________________________ Emergency Contacts: (persons allowed to sign your child out of the program): Name: _______________________________Relationship to child: _________Phone # ______/______/__________ Name: _______________________________Relationship to child: _________Phone # ______/______/__________ Week Date Theme Need Add A Breezers / Sun Crew Extended Fit Day? Care? Example June 15-19 The Hollywood Connection o Yes oTue. oThu. o 1 June 13-17 Fantasy Fun o Yes oTue. oThu. o 2 June 20-24 Roll On o Yes oTue. oThu. o 3 June 27-July 1 No Siesta, All Fiesta o Yes oTue. oThu. o 4 July 5-8 No Theme, All Fun - TBD o Yes oTue. oThu. o 5 July 11-15 Island Adventure o Yes oTue. oThu. o 6 July 18-22 The Sky is the Limit o Yes oTue. oThu. o 7 July 25-29 Fun & Adventure o Yes oTue. oThu. o 8 Aug. 1-5 Games Galore / Outside the Box o Yes oTue. oThu. o 9 Aug. 8-12 Outside the Box / Games Galore o Yes oTue. oThu. o 10 August 15-19 Caribbean Carnival o Yes oTue. oThu. Please complete this application; one application per child. When complete either snap a photo or scan the application and e-mail it to, mail it to HFFA, Attn: Re- becca Taylor, PO Box 1979, Huntersville, NC 28070 or bring it to HFFA Guest Relations Desk. Staff use only: Received:_______ E-mailed:______ Account Confrmed: _______ Billing Confrmation:_______ Summer Breezers • Summer Sun Crew Full Day Camps • Registration Form (One Per Child) 2016 SIZZLIN' SUMMER CAMPS R5

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