Huntersville Family Fitness & Aquatics

2017

Issue link: http://hffasummercamp.epubxp.com/i/796899

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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 Select your desired week(s) 1 June 27 - June 30 o 2 July 4 - July 7 o Please complete this application; one application per child. When complete either snap a photo or scan the application and e-mail it to rtaylor@huntersville.org, 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:_______ Empower Sports Registration Form (One Per Child) R7

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