Registration Form

Student First name/Nombre

Last name/Apellido

Parent Email/Correo Electronico del Padre/Tutor

Student ID Number/Numero de Identificacion de Estudiante

Date of Birth/Fecha de Nacimiento

School /Escuela

Parent/Guardian Full Name- Nombre de Padres

Parent/Guardian Phone Number- Email de Padres

This program runs Monday through Friday 8am-2pm. Does your child require aftercare provided by the Boys and Girls Club available 2pm-6pm? Note that a separate registration must be completed.

Yes

No

Este programa funciona de lunes a viernes de 8:00 a 14:00. ¿Su hijo/a necesita el servicio de guardería del Boys and Girls Club, disponible de 14:00 a 18:00? Tenga en cuenta que se requiere registrars

Yes

No

Does your child have health insurance?/Su hijo(a) tiene seguro medico?

Yes

No

If yes, please provide the name and policy number for your child:

If no, would you be interested in finding out more about insurance/health care options?/Si no, esta interesado en recibir opciones?

Yes

No

Does your child have any allergies?/Su hijo(a) tiene alguna alergia?

Yes

No

If yes, what allergies does your child have?/ Si contesto si, cuales son las alergias?

The COOL Program will be partnering with The Harbor to connect families to free resources, supports and services they may need. Would you like your information to be provided?

Yes

No

El programa COOL se asocia con la organizacion 'The Harbor' para conectar a familias con recursos, apoyo o servicios que puedan ser utiles. Le gustaria recibir informacion adicional?

Yes

No

Sports Programming: (Please be aware all children participating in sports programming will require a current sports physical to be provided prior to participation) Select from the following options:

Football

Basketball

Volleyball

Weight Training

Yoga

Deportes- Por favor tenga en cuenta que todos los estudiantes que participan en los deportes necesitan tener un examen fisico antes de comenzar. Por favor seleccione los deportes de la lista:

Yoga

Futbol Americano

Baloncesto

Voleibol

Entrenamiento

I, as the participant or parent or legal guardian of the above-named child(ren), hereby give permission for his/her/their participation in the above-listed activity(ies).

Yes

I authorize, without my prior approval, the rendering of any emergency medical treatment that may become necessary due to his/her/my participation in the activity(ies).

I agree

I have read this release and fully understand its terms. I execute the release voluntarily and with full knowledge of its significance and consequences.

I agree

I have read, understand, and agree to the media release provided.

I agree

I have read, understand, and agree to the sports release provided.

I agree

Vegas Force Foundation

1.COOL Summer Registration Form

2.Event Policies

COOL Summer- Free