Uptown Columbus

Chattahoochee Adventure Club Camp

Application: please fill out a separate application for each camper attending.

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Camper's Name:
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DOB:
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Age on June 4th, 2018:
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Parent(s') Name:
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Email Address:
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Home Address:
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Cell Phone:
Home Phone:
Work Phone:
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Can your Child Swim:
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Height:
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Weight:
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Medical Conditions:
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Date of last Tetanus Shot or Booster:
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T-shirt Size (Youth Sizes):
Participant Information Disclosure Consent and Release:
I wish to participate in a Whitewater Management LCC daycamp/recreation event. I acknowledge that I am fully aware that the activities associated with this event entail certain inherent risks including damage to property, personal injury and even death. In consideration for being permitted to participate in this activity, I agree to assume all such risks and herby release and discharge Uptown Whitewater Management LLC, Whitewater Express and Uptown Columbus, Inc., its officers, sponsors, trustees, employees, agents and other aids and/or volunteers from any and all liability for any and all damage, loss, injury and death of every kin and nature whatsoever, which is any away arises out of my participation in this activity.

I hereby give permission to the medical personnel selected by the camp to order X-rays, routine tests and treatment for my child. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp to hospitalize, secure proper treatment for and to order injection and/or anesthesia and/or surgery for my child. I give permission for my child to be transported in a private vehicle. I give permission for photographs taken of me/my child for publicity.

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Signature of Parent:
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Date:
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Emergency Contact:
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Phone:

Documents:
no registration will be considered complete until all documentation is received by Uptown Columbus, Inc.



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Type of Camper:





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Payment Options:



Mailing Address:
Uptown Columbus
Attn: Becca Zajac
P.O. Box 1237
Columbus, Georgia 31902
Office Address:
Uptown Columbus
25 West 10th Street, Suite 4
Columbus, Georgia 31901


Please complete payment and return forms to the address listed above, no later than May 31st. Spots are first come, first served with a max of 48 campers. Each year our camp has sold out.

If you have any additional questions, please contact Becca Zajac at 706.596.0111 or becca@uptowncolumbusga.com