2018 Summer Camp Registration

Boys & Girls Club of East Providence
Camp Crosby
Annawamscutt Drive 
Bristol, RI
www.epbgc.org
www.campcrosby.org

Camp Registration

Please check which sessions your child will attend *

Participant Information

calendar
Ethnicity
 
Does your child know how to swim? *

Household / Contact Information

Is anyone in the household a member of the military of National Guard *
Does you child receive free or reduced lunch at school *

Health Information

Any restrictions of activity due to medical activity, if yes explain *
 


This health information is correct to the best of my knowledge and the person herein described has permission to engage in all prescribed activities, except as noted by me and the physician. I authorize the Boys & Girls Club of East Providence to arrange for medical examination and/or treatment of my child should an emergency arise in any Boys & Girls Club program. It is understood that every effort will be made to contact the emergency numbers provided before any medical action is taken. *
Individuals other than parents/guardians who are authorized to pick up child. Please include their phone number. Reminder anyone picking up should have their photo ID for staff to confirm their identity.
 First NameLast NamePhone NumberEmergency contact(Y/N)
Contact
Contact
Contact
Contact
Contact
Contact
Contact
Contact
Field Trip Permission 

I hereby grant permission for my child to visit Colt State Park or Bristol Common on field trips with the Camp Crosby. Summer Program, during the summer of 2017. *
Camp Crosby Handbook Acknowledgement

I hereby acknowledge that I received and have reviewed the Boys & Girls Club of East Providence’s Camp Crosby Parent Handbook.

Handbook can be downloaded here *
I have read the completed application, understand the rules of the Boys & Girls Clubs and request that my son/daughter be admitted into membership. I have explained the rules to my son/daughter and agree that the Boys & Girls Club will not be responsible for any accident to the boy/girl while on the Club premises or while engaged in any of its activities away from the Club. I give my consent for photographs, in which my son/daughter may appear, to be used in any way by the Boys & Girls Club. The Boys and Girls Club reserves the right to revoke membership at any time. *
I understand that by clicking submit here I am registering my child for Camp Crosby pending payment of the weekly fee and membership (if applicable). When this application is received at the office, the EPBGC staff will contact me to calculate the weekly fee based on the sliding scale and to arrange payment (either via credit card over the phone or check). I understand that if payment is not received, my child is not eligible to attend camp. *