Registration

If you have questions please contact:

Mark Ackerle: 518-644-2332 (home/office)
Jason Ward: 518-857-8468 (mobile)

Please fill out one form for each child you are registering.
Child’s Name: (*)
Child’s Age: (*)
Member: (*) Yes (child or grandchild)
No
Relationship:
T-Shirt Size: Youth Adult       Sm Med Lg

Register for Sailing
Child’s Ability Level:
Program Dates: Entire Season
Week 1 June 29 – July 2
Week 2 July 6 – July 9
Week 3 July 13 – July 16
Week 4 July 20 – July 23		  
Week 5 July 27 – July 30
Week 6 Aug 3 – Aug 6
Week 7 Aug 10 – Aug 13
Week 8 Aug 17 – Aug 20
Cheeseburger Regatta (at NLGYC) July 28, 29, 30

Register for Swimming

Child’s Ability Level:
Program Dates: Entire Season
Week 1 June 29 – July 2
Week 2 July 6 – July 9
Week 3 July 13 – July 16
Week 4 July 20 – July 23		  
Week 5 July 27 – July 30
Week 6 Aug 3 – Aug 6
Week 7 Aug 10 – Aug 13
Week 8 Aug 17 – Aug 20
Diamond Island Swim- Aug 10 Tuesday
Long Island Swim- August 11 Wednesday

Register for Tennis
Child’s Ability Level:
Program Dates: Entire Season
Week 1 June 29 – July 2
Week 2 July 6 – July 9
Week 3 July 13 – July 16
Week 4 July 20 – July 23		  
Week 5 July 27 – July 30
Week 6 Aug 3 – Aug 6
Week 7 Aug 10 – Aug 13
Week 8 Aug 17 – Aug 20
Junior Banquet -August 22 ( Sunday)
Member’s Name: (*)
Member’s Email Address: (*)
Address: (*)
City: (*)
State: (*)
Zip: (*)
Phone: (*)
Member Number: (*) - i.e. A-28

Health and Medical Forms

Preliminary registration is welcomed with the above information, but registration is not complete until a Health Form and a Medical Authorization Form are both submitted and on file with Club staff. These forms will be mailed with the 2009 Junior Sports brochure, or you can obtain blank forms at the Club. And, it will be of great help and speed up a child’s first day if the information for the forms is completed and submitted with the above registration. Thank you..

Information for Junior Program Health Form and Authorization for Medical Treatment of Minors
Name of Minor:
Birth Date:
Known Allergies:
Special Conditions:
Date of Last Tetanus Shot:
Medications Now Being Taken:
Hospitalization Coverage for Above Minor:
Insurance Company:
ID or Contract Number:
Group and/or Person Named on Policy:
Pediatrician / Family Physician:
Name:
Address:
Telephone:
Name of Parent or Designated Guardian:
Authorized Signature:
(Person who is on Club property while the child is on Club grounds)
Emergency Contacts:
Name(s):
Telephone(s):
Date providing the above information:
* - indicates Required Field