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BHSC Summer “Kids Club” Program Registration Summer 2018

BHSC Summer “Kids Club” Program Registration Summer 2018

Today's Date: April 23, 2024

First Participant Name

First Name*

Last Name*

Phone*
First Participant Age Acknowledgment*
First Participant Date of Birth*
I certify that I am 18 years of age or older
First Participant Information

Start Date:

End Date:

(Please complete all item lines below)

Selected Program:*

Child's Nickname:

Previous Day Care or Schools Attended: *

Grade: *

Child's Physician: *

Phone: *

Complete Address: *

Allergies:

Physical/Developmental Information:

Please List Any Special Accommodations:

(It is the responsibility of the parents to inform the Director with updated information)

Authorization for Emergency Medical Care and other BHSC policies 

I authorize Boars Head Sports Club staff to provide emergency medical care should an emergency occur when the parent cannot be located immediately. According to state law, this authorization is not required if the parent states an objection to the provision of such care on religious or other grounds.


I Agree

The Boar's Head child care staff has the right to exclude your child from the program if he/she has a temperature of 100 degrees F or more; if he/she has recurrent vomiting or diarrhea; or if exclusion is recommended according to the Virginia Department of Health's communicable disease recommendations. I understand that if my child becomes ill while in the care of Boar's Head staff, I will be notified and must make arrangements to have my child picked up immediately.

I Agree

During participation in Child Care, classes and Summer Kids Club, photographs which embody the spirit and nature of the programs at Boar's Head Sports Club are occasionally taken of participants. Your signature below authorizes Boar's Head to print, publish, and display pictures or videos of you, other members of your family, and the participant registered above in various publications, on the Boars Head web site, and in the public media.

I Agree

I further agree to inform the Boars Head Sports Club within 24 hours, or the next business day, after my child or any member of my immediate household has developed any reportable communicable disease, as defined by the State Board of Health, except for life threatening diseases, which must be reported immediately. Our policy is that we DO NOT administer medications (prescription or nonprescription) to campers. Please note; we do not consider sunscreen a medication, you will be ask for consent for our team to apply sunscreen to your child on a separate document

I Agree

By signing below I have read and consented to all of the policies and procedures set forth by Boar's Head Sports Club for their children's programs. On behalf of myself and my child, I forever release and hold harmless Boar's Head Inn and Sports Club from any claim, suit, demand or cause of action resulting from any injury to my child during the time the child is in the care of staff, except such injury as may arise out of gross negligence or intentional misconduct.

I Agree

I understand that a number of activities and events offered by the sports club, including this organized program, may involve inherent danger and risk of personal injury. I accept these risks on behalf of myself and my child.

I Agree
First Participant Signature*
Second Participant Name

First Name*

Last Name*
Second Participant Date of Birth*
Second Participant Information

Start Date:

End Date:

(Please complete all item lines below)

Selected Program:*

Child's Nickname:

Previous Day Care or Schools Attended: *

Grade: *

Child's Physician: *

Phone: *

Complete Address: *

Allergies:

Physical/Developmental Information:

Please List Any Special Accommodations:

(It is the responsibility of the parents to inform the Director with updated information)

Authorization for Emergency Medical Care and other BHSC policies 

I authorize Boars Head Sports Club staff to provide emergency medical care should an emergency occur when the parent cannot be located immediately. According to state law, this authorization is not required if the parent states an objection to the provision of such care on religious or other grounds.


I Agree

The Boar's Head child care staff has the right to exclude your child from the program if he/she has a temperature of 100 degrees F or more; if he/she has recurrent vomiting or diarrhea; or if exclusion is recommended according to the Virginia Department of Health's communicable disease recommendations. I understand that if my child becomes ill while in the care of Boar's Head staff, I will be notified and must make arrangements to have my child picked up immediately.

I Agree

During participation in Child Care, classes and Summer Kids Club, photographs which embody the spirit and nature of the programs at Boar's Head Sports Club are occasionally taken of participants. Your signature below authorizes Boar's Head to print, publish, and display pictures or videos of you, other members of your family, and the participant registered above in various publications, on the Boars Head web site, and in the public media.

I Agree

I further agree to inform the Boars Head Sports Club within 24 hours, or the next business day, after my child or any member of my immediate household has developed any reportable communicable disease, as defined by the State Board of Health, except for life threatening diseases, which must be reported immediately. Our policy is that we DO NOT administer medications (prescription or nonprescription) to campers. Please note; we do not consider sunscreen a medication, you will be ask for consent for our team to apply sunscreen to your child on a separate document

I Agree

By signing below I have read and consented to all of the policies and procedures set forth by Boar's Head Sports Club for their children's programs. On behalf of myself and my child, I forever release and hold harmless Boar's Head Inn and Sports Club from any claim, suit, demand or cause of action resulting from any injury to my child during the time the child is in the care of staff, except such injury as may arise out of gross negligence or intentional misconduct.

I Agree

I understand that a number of activities and events offered by the sports club, including this organized program, may involve inherent danger and risk of personal injury. I accept these risks on behalf of myself and my child.

I Agree
Third Participant Name

First Name*

Last Name*
Third Participant Date of Birth*
Third Participant Information

Start Date:

End Date:

(Please complete all item lines below)

Selected Program:*

Child's Nickname:

Previous Day Care or Schools Attended: *

Grade: *

Child's Physician: *

Phone: *

Complete Address: *

Allergies:

Physical/Developmental Information:

Please List Any Special Accommodations:

(It is the responsibility of the parents to inform the Director with updated information)

Authorization for Emergency Medical Care and other BHSC policies 

I authorize Boars Head Sports Club staff to provide emergency medical care should an emergency occur when the parent cannot be located immediately. According to state law, this authorization is not required if the parent states an objection to the provision of such care on religious or other grounds.


I Agree

The Boar's Head child care staff has the right to exclude your child from the program if he/she has a temperature of 100 degrees F or more; if he/she has recurrent vomiting or diarrhea; or if exclusion is recommended according to the Virginia Department of Health's communicable disease recommendations. I understand that if my child becomes ill while in the care of Boar's Head staff, I will be notified and must make arrangements to have my child picked up immediately.

I Agree

During participation in Child Care, classes and Summer Kids Club, photographs which embody the spirit and nature of the programs at Boar's Head Sports Club are occasionally taken of participants. Your signature below authorizes Boar's Head to print, publish, and display pictures or videos of you, other members of your family, and the participant registered above in various publications, on the Boars Head web site, and in the public media.

I Agree

I further agree to inform the Boars Head Sports Club within 24 hours, or the next business day, after my child or any member of my immediate household has developed any reportable communicable disease, as defined by the State Board of Health, except for life threatening diseases, which must be reported immediately. Our policy is that we DO NOT administer medications (prescription or nonprescription) to campers. Please note; we do not consider sunscreen a medication, you will be ask for consent for our team to apply sunscreen to your child on a separate document

I Agree

By signing below I have read and consented to all of the policies and procedures set forth by Boar's Head Sports Club for their children's programs. On behalf of myself and my child, I forever release and hold harmless Boar's Head Inn and Sports Club from any claim, suit, demand or cause of action resulting from any injury to my child during the time the child is in the care of staff, except such injury as may arise out of gross negligence or intentional misconduct.

I Agree

I understand that a number of activities and events offered by the sports club, including this organized program, may involve inherent danger and risk of personal injury. I accept these risks on behalf of myself and my child.

I Agree
Fourth Participant Name

First Name*

Last Name*
Fourth Participant Date of Birth*
Fourth Participant Information

Start Date:

End Date:

(Please complete all item lines below)

Selected Program:*

Child's Nickname:

Previous Day Care or Schools Attended: *

Grade: *

Child's Physician: *

Phone: *

Complete Address: *

Allergies:

Physical/Developmental Information:

Please List Any Special Accommodations:

(It is the responsibility of the parents to inform the Director with updated information)

Authorization for Emergency Medical Care and other BHSC policies 

I authorize Boars Head Sports Club staff to provide emergency medical care should an emergency occur when the parent cannot be located immediately. According to state law, this authorization is not required if the parent states an objection to the provision of such care on religious or other grounds.


I Agree

The Boar's Head child care staff has the right to exclude your child from the program if he/she has a temperature of 100 degrees F or more; if he/she has recurrent vomiting or diarrhea; or if exclusion is recommended according to the Virginia Department of Health's communicable disease recommendations. I understand that if my child becomes ill while in the care of Boar's Head staff, I will be notified and must make arrangements to have my child picked up immediately.

I Agree

During participation in Child Care, classes and Summer Kids Club, photographs which embody the spirit and nature of the programs at Boar's Head Sports Club are occasionally taken of participants. Your signature below authorizes Boar's Head to print, publish, and display pictures or videos of you, other members of your family, and the participant registered above in various publications, on the Boars Head web site, and in the public media.

I Agree

I further agree to inform the Boars Head Sports Club within 24 hours, or the next business day, after my child or any member of my immediate household has developed any reportable communicable disease, as defined by the State Board of Health, except for life threatening diseases, which must be reported immediately. Our policy is that we DO NOT administer medications (prescription or nonprescription) to campers. Please note; we do not consider sunscreen a medication, you will be ask for consent for our team to apply sunscreen to your child on a separate document

I Agree

By signing below I have read and consented to all of the policies and procedures set forth by Boar's Head Sports Club for their children's programs. On behalf of myself and my child, I forever release and hold harmless Boar's Head Inn and Sports Club from any claim, suit, demand or cause of action resulting from any injury to my child during the time the child is in the care of staff, except such injury as may arise out of gross negligence or intentional misconduct.

I Agree

I understand that a number of activities and events offered by the sports club, including this organized program, may involve inherent danger and risk of personal injury. I accept these risks on behalf of myself and my child.

I Agree
Fifth Participant Name

First Name*

Last Name*
Fifth Participant Date of Birth*
Fifth Participant Information

Start Date:

End Date:

(Please complete all item lines below)

Selected Program:*

Child's Nickname:

Previous Day Care or Schools Attended: *

Grade: *

Child's Physician: *

Phone: *

Complete Address: *

Allergies:

Physical/Developmental Information:

Please List Any Special Accommodations:

(It is the responsibility of the parents to inform the Director with updated information)

Authorization for Emergency Medical Care and other BHSC policies 

I authorize Boars Head Sports Club staff to provide emergency medical care should an emergency occur when the parent cannot be located immediately. According to state law, this authorization is not required if the parent states an objection to the provision of such care on religious or other grounds.


I Agree

The Boar's Head child care staff has the right to exclude your child from the program if he/she has a temperature of 100 degrees F or more; if he/she has recurrent vomiting or diarrhea; or if exclusion is recommended according to the Virginia Department of Health's communicable disease recommendations. I understand that if my child becomes ill while in the care of Boar's Head staff, I will be notified and must make arrangements to have my child picked up immediately.

I Agree

During participation in Child Care, classes and Summer Kids Club, photographs which embody the spirit and nature of the programs at Boar's Head Sports Club are occasionally taken of participants. Your signature below authorizes Boar's Head to print, publish, and display pictures or videos of you, other members of your family, and the participant registered above in various publications, on the Boars Head web site, and in the public media.

I Agree

I further agree to inform the Boars Head Sports Club within 24 hours, or the next business day, after my child or any member of my immediate household has developed any reportable communicable disease, as defined by the State Board of Health, except for life threatening diseases, which must be reported immediately. Our policy is that we DO NOT administer medications (prescription or nonprescription) to campers. Please note; we do not consider sunscreen a medication, you will be ask for consent for our team to apply sunscreen to your child on a separate document

I Agree

By signing below I have read and consented to all of the policies and procedures set forth by Boar's Head Sports Club for their children's programs. On behalf of myself and my child, I forever release and hold harmless Boar's Head Inn and Sports Club from any claim, suit, demand or cause of action resulting from any injury to my child during the time the child is in the care of staff, except such injury as may arise out of gross negligence or intentional misconduct.

I Agree

I understand that a number of activities and events offered by the sports club, including this organized program, may involve inherent danger and risk of personal injury. I accept these risks on behalf of myself and my child.

I Agree
Sixth Participant Name

First Name*

Last Name*
Sixth Participant Date of Birth*
Sixth Participant Information

Start Date:

End Date:

(Please complete all item lines below)

Selected Program:*

Child's Nickname:

Previous Day Care or Schools Attended: *

Grade: *

Child's Physician: *

Phone: *

Complete Address: *

Allergies:

Physical/Developmental Information:

Please List Any Special Accommodations:

(It is the responsibility of the parents to inform the Director with updated information)

Authorization for Emergency Medical Care and other BHSC policies 

I authorize Boars Head Sports Club staff to provide emergency medical care should an emergency occur when the parent cannot be located immediately. According to state law, this authorization is not required if the parent states an objection to the provision of such care on religious or other grounds.


I Agree

The Boar's Head child care staff has the right to exclude your child from the program if he/she has a temperature of 100 degrees F or more; if he/she has recurrent vomiting or diarrhea; or if exclusion is recommended according to the Virginia Department of Health's communicable disease recommendations. I understand that if my child becomes ill while in the care of Boar's Head staff, I will be notified and must make arrangements to have my child picked up immediately.

I Agree

During participation in Child Care, classes and Summer Kids Club, photographs which embody the spirit and nature of the programs at Boar's Head Sports Club are occasionally taken of participants. Your signature below authorizes Boar's Head to print, publish, and display pictures or videos of you, other members of your family, and the participant registered above in various publications, on the Boars Head web site, and in the public media.

I Agree

I further agree to inform the Boars Head Sports Club within 24 hours, or the next business day, after my child or any member of my immediate household has developed any reportable communicable disease, as defined by the State Board of Health, except for life threatening diseases, which must be reported immediately. Our policy is that we DO NOT administer medications (prescription or nonprescription) to campers. Please note; we do not consider sunscreen a medication, you will be ask for consent for our team to apply sunscreen to your child on a separate document

I Agree

By signing below I have read and consented to all of the policies and procedures set forth by Boar's Head Sports Club for their children's programs. On behalf of myself and my child, I forever release and hold harmless Boar's Head Inn and Sports Club from any claim, suit, demand or cause of action resulting from any injury to my child during the time the child is in the care of staff, except such injury as may arise out of gross negligence or intentional misconduct.

I Agree

I understand that a number of activities and events offered by the sports club, including this organized program, may involve inherent danger and risk of personal injury. I accept these risks on behalf of myself and my child.

I Agree
Seventh Participant Name

First Name*

Last Name*
Seventh Participant Date of Birth*
Seventh Participant Information

Start Date:

End Date:

(Please complete all item lines below)

Selected Program:*

Child's Nickname:

Previous Day Care or Schools Attended: *

Grade: *

Child's Physician: *

Phone: *

Complete Address: *

Allergies:

Physical/Developmental Information:

Please List Any Special Accommodations:

(It is the responsibility of the parents to inform the Director with updated information)

Authorization for Emergency Medical Care and other BHSC policies 

I authorize Boars Head Sports Club staff to provide emergency medical care should an emergency occur when the parent cannot be located immediately. According to state law, this authorization is not required if the parent states an objection to the provision of such care on religious or other grounds.


I Agree

The Boar's Head child care staff has the right to exclude your child from the program if he/she has a temperature of 100 degrees F or more; if he/she has recurrent vomiting or diarrhea; or if exclusion is recommended according to the Virginia Department of Health's communicable disease recommendations. I understand that if my child becomes ill while in the care of Boar's Head staff, I will be notified and must make arrangements to have my child picked up immediately.

I Agree

During participation in Child Care, classes and Summer Kids Club, photographs which embody the spirit and nature of the programs at Boar's Head Sports Club are occasionally taken of participants. Your signature below authorizes Boar's Head to print, publish, and display pictures or videos of you, other members of your family, and the participant registered above in various publications, on the Boars Head web site, and in the public media.

I Agree

I further agree to inform the Boars Head Sports Club within 24 hours, or the next business day, after my child or any member of my immediate household has developed any reportable communicable disease, as defined by the State Board of Health, except for life threatening diseases, which must be reported immediately. Our policy is that we DO NOT administer medications (prescription or nonprescription) to campers. Please note; we do not consider sunscreen a medication, you will be ask for consent for our team to apply sunscreen to your child on a separate document

I Agree

By signing below I have read and consented to all of the policies and procedures set forth by Boar's Head Sports Club for their children's programs. On behalf of myself and my child, I forever release and hold harmless Boar's Head Inn and Sports Club from any claim, suit, demand or cause of action resulting from any injury to my child during the time the child is in the care of staff, except such injury as may arise out of gross negligence or intentional misconduct.

I Agree

I understand that a number of activities and events offered by the sports club, including this organized program, may involve inherent danger and risk of personal injury. I accept these risks on behalf of myself and my child.

I Agree
Eighth Participant Name

First Name*

Last Name*
Eighth Participant Date of Birth*
Eighth Participant Information

Start Date:

End Date:

(Please complete all item lines below)

Selected Program:*

Child's Nickname:

Previous Day Care or Schools Attended: *

Grade: *

Child's Physician: *

Phone: *

Complete Address: *

Allergies:

Physical/Developmental Information:

Please List Any Special Accommodations:

(It is the responsibility of the parents to inform the Director with updated information)

Authorization for Emergency Medical Care and other BHSC policies 

I authorize Boars Head Sports Club staff to provide emergency medical care should an emergency occur when the parent cannot be located immediately. According to state law, this authorization is not required if the parent states an objection to the provision of such care on religious or other grounds.


I Agree

The Boar's Head child care staff has the right to exclude your child from the program if he/she has a temperature of 100 degrees F or more; if he/she has recurrent vomiting or diarrhea; or if exclusion is recommended according to the Virginia Department of Health's communicable disease recommendations. I understand that if my child becomes ill while in the care of Boar's Head staff, I will be notified and must make arrangements to have my child picked up immediately.

I Agree

During participation in Child Care, classes and Summer Kids Club, photographs which embody the spirit and nature of the programs at Boar's Head Sports Club are occasionally taken of participants. Your signature below authorizes Boar's Head to print, publish, and display pictures or videos of you, other members of your family, and the participant registered above in various publications, on the Boars Head web site, and in the public media.

I Agree

I further agree to inform the Boars Head Sports Club within 24 hours, or the next business day, after my child or any member of my immediate household has developed any reportable communicable disease, as defined by the State Board of Health, except for life threatening diseases, which must be reported immediately. Our policy is that we DO NOT administer medications (prescription or nonprescription) to campers. Please note; we do not consider sunscreen a medication, you will be ask for consent for our team to apply sunscreen to your child on a separate document

I Agree

By signing below I have read and consented to all of the policies and procedures set forth by Boar's Head Sports Club for their children's programs. On behalf of myself and my child, I forever release and hold harmless Boar's Head Inn and Sports Club from any claim, suit, demand or cause of action resulting from any injury to my child during the time the child is in the care of staff, except such injury as may arise out of gross negligence or intentional misconduct.

I Agree

I understand that a number of activities and events offered by the sports club, including this organized program, may involve inherent danger and risk of personal injury. I accept these risks on behalf of myself and my child.

I Agree
Ninth Participant Name

First Name*

Last Name*
Ninth Participant Date of Birth*
Ninth Participant Information

Start Date:

End Date:

(Please complete all item lines below)

Selected Program:*

Child's Nickname:

Previous Day Care or Schools Attended: *

Grade: *

Child's Physician: *

Phone: *

Complete Address: *

Allergies:

Physical/Developmental Information:

Please List Any Special Accommodations:

(It is the responsibility of the parents to inform the Director with updated information)

Authorization for Emergency Medical Care and other BHSC policies 

I authorize Boars Head Sports Club staff to provide emergency medical care should an emergency occur when the parent cannot be located immediately. According to state law, this authorization is not required if the parent states an objection to the provision of such care on religious or other grounds.


I Agree

The Boar's Head child care staff has the right to exclude your child from the program if he/she has a temperature of 100 degrees F or more; if he/she has recurrent vomiting or diarrhea; or if exclusion is recommended according to the Virginia Department of Health's communicable disease recommendations. I understand that if my child becomes ill while in the care of Boar's Head staff, I will be notified and must make arrangements to have my child picked up immediately.

I Agree

During participation in Child Care, classes and Summer Kids Club, photographs which embody the spirit and nature of the programs at Boar's Head Sports Club are occasionally taken of participants. Your signature below authorizes Boar's Head to print, publish, and display pictures or videos of you, other members of your family, and the participant registered above in various publications, on the Boars Head web site, and in the public media.

I Agree

I further agree to inform the Boars Head Sports Club within 24 hours, or the next business day, after my child or any member of my immediate household has developed any reportable communicable disease, as defined by the State Board of Health, except for life threatening diseases, which must be reported immediately. Our policy is that we DO NOT administer medications (prescription or nonprescription) to campers. Please note; we do not consider sunscreen a medication, you will be ask for consent for our team to apply sunscreen to your child on a separate document

I Agree

By signing below I have read and consented to all of the policies and procedures set forth by Boar's Head Sports Club for their children's programs. On behalf of myself and my child, I forever release and hold harmless Boar's Head Inn and Sports Club from any claim, suit, demand or cause of action resulting from any injury to my child during the time the child is in the care of staff, except such injury as may arise out of gross negligence or intentional misconduct.

I Agree

I understand that a number of activities and events offered by the sports club, including this organized program, may involve inherent danger and risk of personal injury. I accept these risks on behalf of myself and my child.

I Agree
Tenth Participant Name

First Name*

Last Name*
Tenth Participant Date of Birth*
Tenth Participant Information

Start Date:

End Date:

(Please complete all item lines below)

Selected Program:*

Child's Nickname:

Previous Day Care or Schools Attended: *

Grade: *

Child's Physician: *

Phone: *

Complete Address: *

Allergies:

Physical/Developmental Information:

Please List Any Special Accommodations:

(It is the responsibility of the parents to inform the Director with updated information)

Authorization for Emergency Medical Care and other BHSC policies 

I authorize Boars Head Sports Club staff to provide emergency medical care should an emergency occur when the parent cannot be located immediately. According to state law, this authorization is not required if the parent states an objection to the provision of such care on religious or other grounds.


I Agree

The Boar's Head child care staff has the right to exclude your child from the program if he/she has a temperature of 100 degrees F or more; if he/she has recurrent vomiting or diarrhea; or if exclusion is recommended according to the Virginia Department of Health's communicable disease recommendations. I understand that if my child becomes ill while in the care of Boar's Head staff, I will be notified and must make arrangements to have my child picked up immediately.

I Agree

During participation in Child Care, classes and Summer Kids Club, photographs which embody the spirit and nature of the programs at Boar's Head Sports Club are occasionally taken of participants. Your signature below authorizes Boar's Head to print, publish, and display pictures or videos of you, other members of your family, and the participant registered above in various publications, on the Boars Head web site, and in the public media.

I Agree

I further agree to inform the Boars Head Sports Club within 24 hours, or the next business day, after my child or any member of my immediate household has developed any reportable communicable disease, as defined by the State Board of Health, except for life threatening diseases, which must be reported immediately. Our policy is that we DO NOT administer medications (prescription or nonprescription) to campers. Please note; we do not consider sunscreen a medication, you will be ask for consent for our team to apply sunscreen to your child on a separate document

I Agree

By signing below I have read and consented to all of the policies and procedures set forth by Boar's Head Sports Club for their children's programs. On behalf of myself and my child, I forever release and hold harmless Boar's Head Inn and Sports Club from any claim, suit, demand or cause of action resulting from any injury to my child during the time the child is in the care of staff, except such injury as may arise out of gross negligence or intentional misconduct.

I Agree

I understand that a number of activities and events offered by the sports club, including this organized program, may involve inherent danger and risk of personal injury. I accept these risks on behalf of myself and my child.

I Agree
Participant Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Additional Information

Mother's Name:

Home Phone:

Complete Address:

Place of Employment:

Work Phone:

Father's Name:

Home Phone:

Complete Address:

Place of Employment:

Work Phone:

People Authorized to Pick Up Child: *

People NOT Authorized to Pick Up Child:

 Appropriate paper work such as divorce decree must be attached if a parent is not allowed to pick up the child. 

Emergency Contacts (must have 2 physical addresses (not the same addresses & phone other than parents).


Name: *

Phone: *

Complete Address: *

Name: *

Phone: *

Complete Address: *
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Information

Start Date:

End Date:

(Please complete all item lines below)

Selected Program:*

Child's Nickname:

Previous Day Care or Schools Attended: *

Grade: *

Child's Physician: *

Phone: *

Complete Address: *

Allergies:

Physical/Developmental Information:

Please List Any Special Accommodations:

(It is the responsibility of the parents to inform the Director with updated information)

Authorization for Emergency Medical Care and other BHSC policies 

I authorize Boars Head Sports Club staff to provide emergency medical care should an emergency occur when the parent cannot be located immediately. According to state law, this authorization is not required if the parent states an objection to the provision of such care on religious or other grounds.


I Agree

The Boar's Head child care staff has the right to exclude your child from the program if he/she has a temperature of 100 degrees F or more; if he/she has recurrent vomiting or diarrhea; or if exclusion is recommended according to the Virginia Department of Health's communicable disease recommendations. I understand that if my child becomes ill while in the care of Boar's Head staff, I will be notified and must make arrangements to have my child picked up immediately.

I Agree

During participation in Child Care, classes and Summer Kids Club, photographs which embody the spirit and nature of the programs at Boar's Head Sports Club are occasionally taken of participants. Your signature below authorizes Boar's Head to print, publish, and display pictures or videos of you, other members of your family, and the participant registered above in various publications, on the Boars Head web site, and in the public media.

I Agree

I further agree to inform the Boars Head Sports Club within 24 hours, or the next business day, after my child or any member of my immediate household has developed any reportable communicable disease, as defined by the State Board of Health, except for life threatening diseases, which must be reported immediately. Our policy is that we DO NOT administer medications (prescription or nonprescription) to campers. Please note; we do not consider sunscreen a medication, you will be ask for consent for our team to apply sunscreen to your child on a separate document

I Agree

By signing below I have read and consented to all of the policies and procedures set forth by Boar's Head Sports Club for their children's programs. On behalf of myself and my child, I forever release and hold harmless Boar's Head Inn and Sports Club from any claim, suit, demand or cause of action resulting from any injury to my child during the time the child is in the care of staff, except such injury as may arise out of gross negligence or intentional misconduct.

I Agree

I understand that a number of activities and events offered by the sports club, including this organized program, may involve inherent danger and risk of personal injury. I accept these risks on behalf of myself and my child.

I Agree
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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