Saint Andrews FEC Camp Registration

First Annual Saint Andrews/FEC Winter Camp January 19-20 2025 for Boys/Girls age 10& up - Registration Form

Camper Information

Camper/Participant First Name: *

Camper/Participant Last Name: *

Camper/Participant Sex *

Male
Female
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Camper/Participant Date of Birth *

Age *

T-Shirt Size

Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
Adult XL
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Team (School or Club) *

Position (Select all that apply)

Utility
Center Back
Center
Attacker
Forward
Left-Handed
Right-Handed
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Coach *

Coach Email *

How did you hear about the Saint Andrews/FEC Winter Classic?

Health Information

Family Physician Contact Information *

Health Insurance Company *

Policy Number *

Allergies to Medication *

Additional Medical Problems/Information: (Asthma, heart murmur, etc.) *

Health Certification and Medical Agreement

I, the parent/guardian of Camper/Participant, certify that s/he is in good health and able to participate in all activities. If my child has special physical limitations, including allergies, asthma, diabetes, or requires medication, I have explained in the space provided.

Emergency Contact and Notification

Emergency Contact Name *

Emergency Contact Relationship *

Emergency Contact Phone *

Emergency Contact Email *

Medical Treatment Authorization

Name of Signing Party (Medical Authorization) *

Relationship to Participant (Medical Authorization) *

Phone *

Email *

Medical Treatment Authorization *

I, the parent/guardian of Camper/Participant, do hereby authorize the Saint Andrews Aquatics staff and its agents to consent to any X-Ray, anesthetic, medical, dental, or surgical diagnosis or treatment and hospital care for the above-named minor, which is deemed advisable by and to be rendered under the supervision of any athletic trainer, physician, surgeon, or dentist.

Payment

Pricing info:
$250 per camper

$200 for FEC or St. Andrews Aquatics members and/or FEC Winter Classic athletes

Please indicate Preferred Payment Method *

Zelle to [email protected]
Check payable to Saint Andrew’s Aquatics 1082 S Rogers Circle Boca Raton, FL 33487
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