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UC San Diego REC - Program Waiver
Participant Info
Participant First Name:
*
Participant Last Name:
*
Participant Contact Phone:
*
Participant Email Address:
*
Participant Birthdate:
*
+
Participant Age:
*
Submitting For:
*
GME Wellness
Challenge Course
WorkStrong
Rec Classes
Fitness & Wellness Classes
Outback Adventures
Sports Clubs
Intramural Sports
Swim San Diego
Welcome Week Event
Sunset Water Polo
Triton Aquatic Club
HDH Facility
Coronado Swim Association
Extension Activity
Dive San Diego
La Jolla Country Day
Jewish Community Center (JCC)
Coggan Aquatics
Surf 55th!
SD Legion
Other
Club Sport:
*
Badminton
Baseball
Cricket
Cycling
Dance Team
Dancesport
Dragon Boat
Equestrian
Field Hockey
Ice Hockey
Gymnastics
Lacrosse - Mens
Lacrosse - Wmns
Rugby - Mens
Rugby - Wmns
Sailing
Ski & Snowboard
Soccer - Mens
Soccer - Wmns
Surfing
Swimming
Table Tennis
Tennis
Triathalon
Ultimate - Mens
Ultimate - Wmns
Volleyball - Mens
Volleyball - Wmns
Water Polo - Mens
Water Polo - Wmns
Cheer Team
Emergency Contact Info
Emergency Contact First Name:
*
Emergency Contact Last Name:
*
Emergency Contact Phone:
*
Relationship to Participant:
*
Parent/Guardian
Spouse/Partner
Immediate Family
Extended Family
Friend