JOE BUDD AQUATIC EDUCATION CENTER
"FISH CAMP" REGISTRATION

JOE BUDD AQUATIC EDUCATION CENTER
“FISH CAMP” REGISTRATION

*Registration opens March 11th
*Please use a separate registration form for each child.
*Children must be nine to fifteen years old.
*For more information about Fish Camp, contact Joe Budd Aquatic Ed Ctr at 933-4322.

A.  Child’s Name________________________________________________Nickname _____________________ Age _______
Birth Date________________________ Grade Completed __________________ Circle Shirt Size  YM YL AS AM AL AXL
Address ______________________________________________________________________________________________
City ___________________________________________ State _______________________ Zip Code __________________

B. Parent/Guardian ___________________________________________________ Home Phone________________________
Work Phone _____________________ Other ______________________ Email _____________________________________

C. Emergency Contact ______________________________________________________
Relationship __________________________ Home Phone _____________________ Work Phone ______________________ Other ________________________________________________________________________________________________

D. Physician _______________________________________________________ Phone______________________________
Explain any medical problems, allergies, handicaps, etc.  ____________________________________________________________________
_____________________________________________________________________________________________________
Is your child on any medications? If so, please explain __________________________________________________________
_____________________________________________________________________________________________________

E.  During boating activities children will be required to wear life jackets and will be closely supervised.  For safety concerns, rate your child’s swimming ability.

(Check one):    Non-Swimmer _____ Beginner _____ Intermediate _____ Advanced _____

F.  Select your choice of Fish Camp by rating two weeks  (1-first choice, 2-second choice).

Campers are registered on a first-come, first-served basis.  If the week you request as first choice is full, we will use your second choice.  If you are limited to one certain week, and it is full, your name will be added to a waiting list and your fee will be returned.  Please inform us if you need to cancel a reservation so that others may take advantage of our program.  There will be no refunds for cancellations after May 20.

****Fish Camp fee of $185.00 is due upon registration****

Make checks payable to Wildlife Foundation of Florida.  Send completed forms and payment to:

Joe Budd Aquatic Education Center, FISH CAMP,
P.O. Box 59
Midway, FL 32343

IMPORTANT!  The following section must be filled out IN FULL for us to process your request.

I, _________________________________, hereby authorize my child, _________________________________________, to participate in activities at the Joe Budd Aquatic Education Center.  In case of an accident requiring medical treatment, I authorize treatment for my child as the attending medical personnel deem appropriate.  I also agree not to hold the Florida Fish and Wildlife Conservation Commission responsible for injuries suffered by my child during activities sponsored by it.

____________________________________________                                         _________________________
(Parent/Guardian Signature)                                                                                    (Date)