Registration

Please follow this 3-Step Process to register your child.

If you have questions please contact:

Tracey Thacker, Junior Program Coordinator/LGC Front Office Manager

STEP 1:

Electronic Registration

Please fill out one form for each child you are registering.
Before you begin please be sure to have all * Required Field information at your fingertips.

Child’s Name: (*)
Child’s Age: (*)
Child’s Gender: (*)
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 28 – July 1 Week 2 July 5–8 Week 3 July 12–15 Week 4 July 19–22	Week 5 July 26 – July 29 Week 6 Aug 2–5 Week 7 Aug 9–12 Week 8 Aug 16–19 Week 9 Aug 23 - 26
	Cheeseburger Regatta (at LGC): July 27, 28, 29, 2011
Register for Swimming
Child’s Ability Level:
Program Dates:	Entire Season Week 1 June 28 – July 1 Week 2 July 5–8 Week 3 July 12–15 Week 4 July 19–22	Week 5 July 26 – July 29 Week 6 Aug 2–5 Week 7 Aug 9–12 Week 8 Aug 16–19 Week 9 Aug 23 - 26
	Diamond Island Swim: August 9, Tuesday Long Island Swim: August 10, Wednesday
Register for Tennis
Child’s Ability Level:
Program Dates:	Entire Season Week 1 June 28 – July 1 Week 2 July 5–8 Week 3 July 12–15 Week 4 July 19–22	Week 5 July 26 – July 29 Week 6 Aug 2–5 Week 7 Aug 9–12 Week 8 Aug 16–19 Week 9 Aug 23 - 26
	Junior Banquet: August 21, Sunday
Member’s Name: (*)
Member’s Email Address: (*)
Address: (*)
City: (*)
State: (*)
Zip: (*)
Phone: (*)
Member Number: (*)	– i.e. A-28

STEP 2:

Electronic Health Information for each child

Registration is not complete until a Health Form and a Medical Authorization Form are both submitted and on file with Club staff. 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.

Child’s 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: (*)
(Person who is on Club property while the child is on Club grounds)
Emergency Contacts:
Name(s): (*)
Telephone(s): (*)
Date providing the above information: (*)

STEP 3:

Medical Authorization Form must be printed and signed

Print this form now, sign it, have a witness sign, and submit it to Tracey Thacker, Junior Program Coordinator/LGC Front Office Manager at lgctracey@yahoo.com, by fax at 518-668-3863, or by sending it to PO Box 175, Diamond Point, NY 12824. It must be on file before your child attends a class.

	Download the Medical Authorization Form (pdf)
Please Affirm: (*)	I have downloaded and printed the Medical Authorization Form

* indicates Required Field