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2026 Extra Week Registration

This form should be completed by the camper's parent/guardian. Please submit one form per camper.

Registration for Extra Week (August 3 - 7) is still open for:
- Big Camp (half day)
- Tennis Academy (week)
- Jr. Fleet Eel Regatta (week)

Camper Information

Camper Name *

Sponsoring GIC Member & Member # *

Camper Relation to Sponsoring Member *

--Select--ChildGrandchildNiece/NephewOther

 

• --Select--
• Child
• Grandchild
• Niece/Nephew
• Other

Age *

Grade entering, Fall 2026 *

Birth Date (Month, Date, Year) *

Extra Big Camp (Half Day)

Campers will play a sport, do an Island activity, and go swimming each day! No lunch is provided or needed.

Check one or all days of attendance:

9:00 am - 12:00 pm (GRADES 1 - 6)

Monday, August 3

Tuesday, August 4

Wednesday, August 5

Thursday, August 6

Friday, August 7

Extra Tennis Academy Week (Mon 8/03 - Fri 8/07)

Check to register:

10:00 am - 12:00 pm (GRADE 4 THRU 18 YEARS OLD)

Jr. Fleet Eel Trophy Regatta Week (Mon 8/03 - Fri 8/07)

Check to register:

9:30 am - 3:30 pm (GRADE 3 THRU 18 YEARS OLD)

Camper's Parent/Guardian Info

*REQUIRED:

Parent/Guardian Name *

Contact #: *

Email *

Gibson Island Club Program Release and Waiver of Liability, Assumption of Risk, and Indemnity and Parental Consent Agreement

By signing below, I hereby approve my child's participation in the Summer Camp, Junior Fleet and/or Academy (collectively "Programs"), including without limitation the Club’s Summer Camp Tuesday Evening Off-Island Activities and any other activities which may be scheduled, all as provided by the Gibson Island Club, Inc. (“Club"). I hereby acknowledge that the participation in the Club’s Programs is a benefit offered to me as part of my Club membership. In consideration of this service, I, individually and on behalf of my child knowingly waive, release, discharge, and agree not to sue the Club and/or the Gibson Island Corporation (“Corporation”), their officers, governors, directors, employees, members, committee members, shareholders, and Program instructors on any claim, cause of action, injury, or damage that my child or I may have that arises out of my child's participation in any Program, and I agree to indemnify and hold harmless the Club and the Corporation from any such claim. I understand that there are certain risks of injury inherent in the Programs’ activities in which my child will participate, and I hereby assume those risks and any claims or damages therefrom, on the account of injury to my child's person or property on behalf of my child, my child's personal representatives, heirs and assigns. I further understand that neither the Club nor the Gibson Island Corporation (“Corporation”) assume any liability for injury or damages which arise or result from my child's participation in the Programs. I certify that my child is healthy and has no physical, mental, or other conditions that restrict my child's full participation in the Program(s), other than those listed on the Consent to Treatment, Emergency Contact & Health History Form. I also understand and agree to assume liability and responsibility for any damage done to the Club's or Corporation’s property or property of others by my child or my guest. I also agree that should my child be disruptive in any of the Programs, an attempt will be made to contact me and then arrangements will be made for my child to be sent home or to a caregiver of my choice. I further agree that if my child is dismissed from any of the Programs because of disruptive behavior, I am not entitled to any refund. I hereby grant the Gibson Island Club permission to use my child’s name, picture, or like in any form of media, print or otherwise that is distributed only to members of the Gibson Island Club and Shareholders.

Signature (Parent or Legal Guardian) *

Emergency Contact Information

*REQUIRED:
Please list two people (other than parents) who may be contacted in case of emergency.

Emergency Contact #1 *

Relationship *

Cell Phone *

Emergency Contact #2 *

Relationship *

Cell Phone *

Pick Up Permissions

The following people (other than parents) may pick up my child. Proper ID will be required.

Name

Contact #:

Name

Contact #:

I give my child permission to walk or ride their bike to and from Camp tent, tennis, golf and/or the Point.

SKIP TO 'SUBMIT' IF YOU HAVE ALREADY SUBMITTED HEALTH INFO

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SKIP TO SUBMIT if this camper was previously registered for any GIC Youth activities in 2026.

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Camper Health Information

Camper health information will be filed in the Business Office until our camp season ends.

Does your child have allergies?

YES

NO

Allergic to:

Does your child have any dietary restrictions?

YES

NO

If YES, please describe:

Does your child have other medical conditions that we should be aware of for camp?

YES

NO

If YES, please describe:

Does your child have any of the following? (please check all that apply)

Asthma

Cerebral Palsy

Diabetes

Epilepsy or Convulsions

Hearing Problem

Heart Condition

Hemophilia

Migraine Headache

Rheumatic Fever

Tuberculosis

Vision Problem

None of these

NONE OF THESE

Please list all medications presently used by child (including over the counter/non-prescription medications):

Name of Family Physician

Phone:

Authorization to Consent to Treatment of a Minor
By signing below, I hereby consent and authorize employees of the Gibson Island Club, Inc. (“Club”) and/or the Gibson Island Corporation (“Corporation”) to provide medical treatment for my child. If the employees of the Club and/or Corporation determine it is necessary to seek emergency treatment, they are authorized to take my child to the nearest emergency room at my expense. In that event, the hospital and its medical staff have my authorization to provide treatment that is deemed necessary for my child. I hereby release and discharge the Club and Corporation, their officers, governors, directors, employees, members, committee members, shareholders and instructors from any and all claims, demands, causes of action which may arise from treatment administered as a result of such injury or illness. Specifically, I do hereby consent to any emergency X-ray, anesthetic medical or surgical diagnosis or treatment and hospital care which is deemed advisable by and is to be rendered under the general or special supervision of any physician or surgeon duly licensed under the provisions of state and federal licensing provisions. It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required but is given to provide authority and power on the part of our aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment or hospital care which the aforementioned physician in the exercise of the physician's best judgment may deem advisable; and neither said agent or any organization involved assumes any financial responsibility for exercising this action. This authorization is given pursuant to the provision of all applicable laws of the State of Maryland.

Signature Parent/Legal Guardian

Camper Health Insurance Information

Name of Insured

Relation to Child

Insurance Provider

Policy #

Preferred Hospital in emergency

Submit