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Registration Form

BayCreek Paddling Center

Rochester, New York

"Hap Paddler",

BayCreek's Web (footed) Master

HapPaddler@baycreek.com

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BayCreek Kids Paddlesports Kamp

Registration and Medical Information Form

(print, complete and bring with child on first day of camp)

Name:

 

Session Date:

 

Date of Birth:

 

Weight:

 

Address:

 

 

 
Phone:      

 

Name of Parent or Legal Guardian:  
In case of emergency, please notify:  

Address:

      

Phone:

      

 

Name of Medical Care Provider:  
Address of Medical Care Provider:  
Phone of Medical Care Provider:  

 

Does the student have any allergies or physical limitations?

Yes

  

No

  

 

If yes, please explain:  
 
 

 

Is the student currently taking any medications?

Yes

  

No

  

 

If yes, please list and explain any precautions that should be taken:  
 
 

 

Make sure you check out all these great pages:

[Sales] [Rentals] [Instruction] [Guided Tours] [Group Programs] [Schedule] [Events]

1099 Empire Blvd. Rochester, NY 14609     (585) 288-2830      Fax: (585) 288-5721