Youth Activities Registration

Child / Participant Information

Registration is not complete until payment is received.
Date Form Completed *
Date Form Completed
Child's Name *
Child's Name
Birthdate *
Birthdate

Parent/Guardian Information

Parent/Guardian *
Parent/Guardian
Primary Phone *
Primary Phone
Secondary Phone *
Secondary Phone
Address *
Address
Parent/Guardian (2)
Parent/Guardian (2)
Primary Phone
Primary Phone
Secondary Phone
Secondary Phone
Address
Address

Authorized to Pick Up

Person(s) Authorized to Pick Up (other than parent/guardian listed above)
Name (1) *
Name (1)
Phone *
Phone
Name (2)
Name (2)
Phone
Phone
Name (3)
Name (3)
Phone
Phone

Emergency Contact

Person(s) other than parent/guardian listed above
Name (1) *
Name (1)
Phone *
Phone
Name (2)
Name (2)
Phone
Phone

Medical Information

Physician’s Name *
Physician’s Name
Phone *
Phone
Address *
Address
Phone *
Phone
Address *
Address

Terms of Agreement

Photography *
Photos may be taken and used to promote the summer camp at Germantown Athletic Club. By signing this, you, the parent/guardian, give permission for your child’s picture to be on the Club website, Facebook, Instagram, Twitter and/or other means of marketing such as newspaper advertisements.
Waiver / Release for Minor *
In consideration for being allowed to participate and/or enroll my child to participate in the activities relating to the Youth Activities, I hereby expressly reassume all risks and hazards, both known and unknown, incidental to my child’s participation in the Youth Activities and assume full responsibility for all risks of bodily harm and property damage resulting from or in connection with my child’s participation in the Youth Activities, including without limitation. I hereby voluntarily release, waive and forever discharge and agree to indemnify and hold harmless, the City of Germantown, its elected officials, officers, employees, agents, representatives and related persons (collectively the “Releasees”) and from any and all liabilities, claims, damages, injuries and losses, including attorney’s fees and courts costs, resulting from, arising out of or connected in any way with my child’s participation in the Youth Activities and related activities; and further agree to indemnify, defend and hold the Releasees harmless from and against any and all liabilities, claims, damages, injuries and losses, including attorney’s fees and courts costs, for personal injury or property damage to any person or entity resulting from or related to my child’s participation in the Youth Activities.
Guardian Name *
Guardian Name

Remember to pay at the Club or online through MY GAC account. 

MEMBERS ONLY
Follow these 4 easy steps to pay online...

  1. Login using the participant's username and password.
  2. Select Classes and Courses.
  3. Choose Enroll in New Course.
  4. Select the activity your child would like to participate in, scroll to the bottom and click Enroll in Course.  

*Please DO NOT place money on your account. The participant must be registered in the specific program for their spot to be secured. 

Contact us with any questions.