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 12-16 Fantasy Fun o Yes oTue. oThu. o 2 June 19-23 Roll On o Yes oTue. oThu. o 3 June 26-30 No Siesta, All Fiesta o Yes oTue. oThu. o 4 July 3,5,6,7 No Theme, All Fun - TBD o Yes oTue. oThu. o 5 July 10-14 Keeping It Cool o Yes oTue. oThu. o 6 July 17-21 The Sky is the Limit o Yes oTue. oThu. o 7 July 24-28 Fun & Adventure o Yes oTue. oThu. o 8 July 31-Aug. 4 Outside the Box o Yes oTue. oThu. o 9 Aug. 7-11 Games Galore o Yes oTue. oThu. o 10 August 14-18 Caribbean Carnival o Yes oTue. oThu. o 11 August 21-25 Goodbye Summer 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 Confirmed: _______ Billing Confirmation:_______ Summer Breezers • Summer Sun Crew Full Day Camps • Registration Form (One Per Child) R5

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