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 Select your desired week(s) 1 June 12-16 Splash Time o 2 June 19-23 Island Explorer o 3 June 26-30 Atlantis o 4 July 3, 5, 6, 7 Fireworks o 5 July 10-14 Desert Oasis o 6 July 17-21 Surf Safari o 7 July 24-28 Paradise o 8 July 31-Aug. 4 Extreme Fun o 9 August 7-11 Exploration Station o 10 August 14-18 Beach Party o 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: Rebecca Taylor, PO Box 1979, Huntersville, NC 28070 or bring it to HFFA Guest Relations Desk. Staff use only: Received:_______ E-mailed:______ Account Confirmed: _______ Billing Confirmation:_______ Fit 2Splash - 1/2 Day Camps Registration Form (One Per Child) R3

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