Miami Beach Rowing Club
High Performance Sweep and Sculling
Summer Camp 2008
Please turn in your application soon, as sessions fill quickly!
Name_________________________
Address_______________________
City/State/Zip _________________
Parent's Cell phone_____________
Camper's Cell phone____________
High School____________________
Option I___II___III___IV___V___
Height_______________________
Weight ______________________
Birth date____________________
Parent's email________________
Camper's email_______________
Grade completed
7___8___9___10___11___12___
Experience Level
_____ Level I (no experience to 3 months of rowing/coxing experience)
_____ Level II (3 months to one year of rowing/coxing experience)
_____ Level III (1 to 2 years of rowing/coxing experience)
_____ Level IV (more than 2 years of rowing/coxing experience)
Payment Method
Check Number __________
Visa/MasterCard
Card Number _______-________-_________-_________ Exp. Date ___/___
Authorized Signature ______________________________ Date ___/___/___
Miami Beach Rowing Club
High Performance Sweep and Sculling
Summer Camp 2008
Medical Release
Emergency information for ___________________________
Parent/Guardian's Name_____________________________
Address_________________________
________________________________
Home Phone ____________________
Work Phone ___________________
Cell Phone _____________________
Parent/Guardian's Name_____________________________
Address________________________
_______________________________
Home Phone_____________________
Work Phone _____________________
Cell Phone ______________________
Person to notify in case neither parent/guardian can be reached:
Name: _______________________________________________
Address: ______________________________________________
Phone:________________________________________________
Physician's name: _________________________
Phone: _________________
Please check with a physician before beginning the rowing program and
list any medical problems or medications that coaches should be aware of.
You may attach an additional sheet if necessary. This information will remain confidential.
__________________________________________________________________________
I certify that my son/daughter (name) _______________________ is in good health and
able to participate in the physical activity of the camp program. The camp has my
permission to provide emergency medical care in the event that my son/daughter is
injured or sick.
Parent signature _______________________________ Date____________
Please attach a copy of your insurance information to this form. Thank You!