CAMPER NAME:__________________________________AGE:_______
PARENT/GUARDIAN NAME:___________________________________
ADDRESS:___________________________________________________
PHONE: (H)______________________(W)_________________________
EMERGENCY #:______________________________________________
Send full payment with Mini Registration Form prior to camp.
***** NO REFUNDS *****
As a convenience to our customers we offer daily rates.
Spring Camp Fees:
Monday – Friday |
9:00 – 3:00 |
$345 |
Per Day |
9:00 – 3:00 |
$90 |
Half Day (M - F) |
9:00 – 12:00 |
$285 |
Per Half Day |
9:00 – 12:00 |
$75 |
Care |
Per Hour |
$10 |
PLEASE INDICATE WHICH DAYS YOU WISH TO ATTEND:
Monday / Tuesday / Wednesday / Thursday / Friday
On the first day of camp bring:
Birth Certificate, Passport, or Report Card.
Immunization Record
Most recent Physical
**CAMPERS BRING A LUNCH AND TWO SNACKS AND LABEL ALL FOOD AND DRINK CONTAINERS WITH NAME AND DATE (Absolutely NO PEANUT PRODUCTS are permitted in lunches). **
COMPLETE THIS FORM AND BRING TO FIRST DAY OF CAMP
CARDINAL GYMNASTIC CENTER DAY CAMP
CHILD’S NAME__________________________________NICKNAME____________________
ADDRESS_________________________________________________ZIP__________
HOME PHONE:__________________________BIRTHDATE:______________AGE:____
PARENTS/ GUARDIAN:
FATHER:___________________________________ CELL PHONE:_________________
PLACE EMPLOYED________________________ __WORK PHONE:________________
MOTHER:__________________________________ CELL PHONE:_________________
PLACE EMPLOYED__________________________ WORK PHONE:_______________
PERSON(S) OR AGENCY HAVING LEGAL CUSTODY OF CHILD:
______________________________________________________________________
ADDRESS_____________________________HOME PHONE:_____________________
EMERGENCY INFORMATION:
PLEASE LIST ANY ALLERGIES OR INTOLERANCE TO FOOD, MEDICATION, ETC:
______________________________________________________________________
PLEASE LIST ANY SPECIAL ACTION WE MUST TAKE IN AN EMERGENCY:
______________________________________________________________________
CHILD’S PHYSICIAN:________________________________________PHONE:______________
NAMES OF TWO PEOPLE TO CONTACT IF PARENTS CAN NOT BE CONTACTED:
1.________________________________________________PHONE:______________
ADDRESS:____________________________________________________________
2. __________________________________________________PHONE:______________
ADDRESS:____________________________________________________________
PERSON(S) AUTHORIZED TO PICK UP CHILD:
______________________________________________________________________
LIST ANY PERSON(S) NOT AUTHORIZED TO PICK UP CHILD:
_________________________________________________________________________________________
LIST ANY CHRONIC PHYSICAL PROBLEMS AND PERTINENT DEVELOPMENTAL INFORMATION:
_________________________________________________________________________________________
(OVER)
1. Cardinal Gymnastics Day Camp agrees to notify the parent/guardian whenever the child becomes ill and the parent/guardian will arrange to have the child picked up as soon as possible.
2. The parent/guardian authorizes Cardinal Gymnastics Day Camp to obtain immediate medical care if any emergency occurs when the parents can not be immediately located. Students are expected to carry their own accident and medical insurance. I agree to be responsible for any medical bills incurred resulting from illness or injury during my child’s participation at Vigo Corporation, Inc.
3. Parents will be notified of any inappropriate or disruptive behavior and staff will attempt to work with the parents to resolve the issue. We do reserve the right to dismiss a child for continued misbehavior.
4. I/We agree to inform Cardinal Gymnastics center within 24 hours after his child or any member of the immediate household has developed any reportable communicable disease.
5. Cardinal Gymnastics Center will not refund camp tuition unless a request is made in writing two weeks prior to the start of the session. There is a $35.00 charge for returned checks. Any request to change from one session to another will be subject to a $15 processing fee.
6. The parent/guardian forever waives and forever releases and discharges Cardinal Gymnastics Center, their officers, directors, owners, employees and agents from all liability for any for any and all damages and injuries suffered by the participant in connection with said use of equipment, instructors and facilities.
7. Cardinal Gymnastics Center is not responsible, whatsoever, for anything that happens before or after the student’s designated class or camp.
8. If a parent or authorized person is late in picking the child up, a late fee of $5 for every 15 minutes will be applied and must be paid that day. A staff member will remain with the child up to one hour after camp ends. After one hour, Child Protective Services will be called.
I have read and agree to the above conditions:
____________________________________________________________________________________
PARENTS OR GUARDIANS DATE
____________________________________________________________________________________
CAMP ADMINISTRATOR DATE
DATE CHILD ENTERED_________________________ ENDING DATE____________________
PLEASE NOTE: ATTACH APPROPRIATE PAPERWORK, SUCH AS DIVORCE DECREE,
IF PARENT IS NOT ALLOWED TO PICK UP CHILD.
GENEALOGY PATHFINDER MARCH 2012 PLACES TO START
0 MEMORANDUM DATE MARCH 8 2006 SUBJECT ACTION
0 N097516 MARCH 25 2010 CLA290OTRRNCN4405 CATEGORY CLASSIFICATION TARIFF
Tags: april 2,, march, april, registration