Registration
WET AND WILD ADVENTURE CAMP
PO Box 92034, Austin, TX  78709-2034       (512) 983-6100

Mary@wetwildcamp.com         Print this page

Session(s)      1        2        3        4       5        6       7        8        9     10    11

Morning drop off (circle):  Central (Westenfield Park),  South  (Patton Elementary),   North (Balcones Park) 
Afternoon pick up (circle):   Central (Austin High School),  South  (Patton),   North (Balcones Park)

Childs Name (name child wants to be called)____________________________________  gender :   boy    girl
Age (when camp starts)_____ Date Of Birth__________ School_____________

Childs Name (name child wants to be called)____________________________________  gender :   boy    girl
Age (when camp starts)_____ Date Of Birth__________ School_____________
Address_________________________________________ zip_________
Phone_________________ E-mail address (print carefully) _________________________

Parent Name______________________________ Phone_______________
    Work Phone________________________            Cell________________

Parent Name_________________________ Phone___________________
    Work Phone______________________     Cell________________

Two emergency contacts (friends or relatives)                                                                             _______________________________________Phone___________________
_______________________________________Phone___________________

How did you hear about us?___________________________________   _

Child's swimming ability:    very strong       strong         fair        weak        very weak

List any special problems your child might have that we need to be aware of, such as allergies, injuries 
or physical limitations.  Is your child on medication? Please provide details. (Use back if necessary)  __________________________________________________________________________

Doctor ____________________ Phone _______________ Insurance _________________________

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Medical and Liability Release
I, the parent of ___________________________release WET & WILD ADVENTURE CAMP, 
as well as its owners and staff members from liability for any injury or illness incurred during his/her 
participation in activities sponsored by this organization.  I hereby give my consent for my child to 
be transported by the staff of WET & WILD ADVENTURE CAMP.  I also give my consent for 
my child to participate in water activities sponsored by WET & WILD ADVENTURE CAMP.   
In the even that I cannot be reached to make arrangements for emergency medical attention for 
above mentioned child, I authorize Mary Robinson or Lucy Grant to arrange for any necessary 
emergency treatment while he/she is in their care.

Parent's signature___________________________             Date_____________