After School Programs
Fall 2017 After School Activities at Little Flower
Fall 2017 Activities at St. Bartholomew’s
Fall 2017 Activities at Blessed Sacrament
CAMP REGISTRATION / MEDICAL FORM
Please fill out the form below in its entirety. All (*) required fields must be filled out.
July 7-11 Conditioning Camp at Blessed Sacrament ($225/Full Week)
Selected Days: July 7-11 ($75/Day)
July 14-18 Conditioning Camp at Blessed Sacrament ($225/Full Week)
Selected Days: July 14-18 ($75/Day)
Camper / Athlete Information
Camper / Athlete Name
Emergency Contact Information
Emergency Contact Name
Emergency Contact Mobile #
Emergency Contact Home #
Emergency Contact Work #
Emergency Contact Home Address
District of Columbia
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
This health history entered below is correct and the camper described has permission to engage in all Xcel Youth Sports activities. In the event that I am unable to be reached in case of emergency, I hereby give permission to the physician selected by the Xcel Youth Sports program director to hospitalize, secure proper treatment, order an injection, anesthesia, or surgery, for my child, as named above.
Date of Last Tetanus Immunization
Primary Provider of Medical Care
Telephone # of Primary Provider of Medical Care
Important Medical Information (i.e. allergies, injuries, medical conditions, etc)
Medical Authorization Form (for campers receiving medicine other than sunscreen)
I hereby request that my child, the above registrant, be given his her medication by the Xcel Youth Sports staff. By entering your information below at the bottom of this form, and clicking submit, you agree to these terms.
NO CHILD WILL BE ALLOWED TO CARRY THEIR OWN MEDICATION
Dosage & Frequency
Proof Of Registration
I hereby request that my child, the above registrant, participate in activities at Xcel Youth Sports Classes. I hereby agree, on behalf of my child, to assume all of the risks in connection with attendance, except in the case of negligence or willful misconduct. By entering your information below and clicking submit, you agree to these terms.
Parent / Guardian Name
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after school programs
Xcel Fitness and Youth Sports | 202-577-4089 | 3609 Spring Street | Chevy Chase, MD 20815 |
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