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Fitness For Kids Summer Camp 2008 The Ridges Registration Form
Age: 2(2nd-3rd) 3( 4th-5th) 4(6th-7th)
Child’s Name: Group (check next school year): 1 (k-1st)
T-Shirt Size (circle one): Youth (S M L ) Adult (S M L ) (All campers will receive 1 t-shirt with registration and must wear their t-shirt every day)
Cost of Camp: $170/week (When you pay before June 8, 2008) Sibling Discount: $160/week Registration Fee: $30 Dates Registration Fee Week 1: June 9- June 13 (Payment Due June 7) Week 2: June 16- June 20 (Payment Due June 9) Week 3: June 23 – June 27 (Payment Due June 16) Week 4: June 30 – July 3 (Payment Due June 23) Week 5: July 7 – July 11 (Payment Due June 30) Week 6: July 14 – July 18 (Payment Due July 7) Week 7: July 21 – July 25 (Payment Due July 14) Week 8: July 28- Aug. 1 (Payment Due July 21) Additional T-Shirts Total Camp Cost Checks should be made payable to: Fitness For Kids. Daily Rate: $40 Cost Check # $180/week (When you pay on or after June 9, 2008) Sibling Discount: $170/week T-Shirts: $12 each Subtotal
$ $ $ $ $ $ $ $ $
30
$ $ $ $ $ $ $ $ $ $ $
30
0 0 0 0 0 0 0 0
0.00
12
30.00
Please mail Registration Form and Payment to: 3801 S.W. 160th Ave. #202 Miramar, FL 33027
For more information, call 954-649-4644 or email at fitnessforkids@yahoo.com. Web: www.f4kweb.com -----------------------------------------------------------------------------------------------------------------------For Office Use Only: Method of Payment- Check#_________ Cash Amount- $_________
Received:
__Registration __Immunization Records __T-Shirt Size____ __Camp Policies Agreement __ Proof of Residency
Date:
_______ _______ _______ _______ _______
Received:
____Health Insurance
Date:
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Notes:______________________________ ___________________________________ ___________________________________ ___________________________________
Registration Form Fitness For Kids Summer Camp 2008
Camper’s name: Next Year’s Grade:
Birth Date: Hair Color:
(e.g. 03/10/1993) Eye Color:
Gender:
Male/Female Height:
Age: Weight: Home Ph: Work Ph: Cell Ph:
Mother’s/Guardian’s Name: Address: E-mail: Father’s/Guardian’s Name: Address: E-mail: Physician’s Name:
Home Ph: Work Ph: Cell Ph: Ph:
Important medical concerns we should be aware of (conditions, medications, health history, etc.):
Child’s Medical Insurance Policy #
(Must provide a copy of child’s insurance card)
Additional people authorized to pick up my child: Name Relationship
Phone
Password*: *Individuals not included on this list will not be eligible to pick-up your child. We ask that you provide us with a “password” in case you need to authorize an additional person over the phone. 1. I understand that payment for the Fitness For Kids will be made in advance for my child participating in the program. 2. I understand that it is necessary to pick my child(ren) up on time. 3. I authorize medical treatment for my child in case of accident or illness while participating in the Fitness For Kids Summer Camp at The Ridges. 4. I give permission for my child to be photographed or videotaped for Fitness For Kids Camp promotions.
Parent/Guardian Signature_________________ Print Name Date
Fitness For Kids Camp Policies
The following policies are in place to ensure your child has a happy, healthy, and safe summer at camp. Please read them carefully and discuss them with your child.
Parents must sign their child IN and OUT of the program at the The Ridges Clubhouse. Parents are not allowed to walk into a classroom (recreational or instructional) and take their child. For the safety of the children, parents must make arrangements with program director for early dismissal. No child will be allowed to leave any building unescorted. Any child with any transmittable infections such as Chicken Pox, Measles, Head Lice or Pink Eye will NOT be allowed in camp. The Fitness For Kids Camp will NOT be responsible for dispensing any medication WITHOUT an original copy of a doctor’s note. Please discuss with program director before registering. Campers are responsible for their personal belongings. The Fitness For Kids camp will not be responsible for lost of stolen valuables, i.e. watches, jewelry, etc. No Trading Cards, Game Boys, i-pods, or cell phones are allowed at camp. Theft and/or vandalism while in the Fitness For Kids Camp may result in immediate dismissal without a refund. Parents will be held financially responsible for repairs or replacement of any item their child damages or destroys. Verbal or physical displays of racial, sexual, or religious discrimination are not permitted. “WWE style” wrestling or any type of physical horse play at camp is not permitted at any time, and may result in suspension from camp without a refund. Weapons, fireworks, lighters, matches and any other incendiaries are not permitted. Children who use physical violence against another child or staff member will be suspended from camp, in accordance to its severity, for a period of time to be determined by the director. Parents will forfeit tuition for that period of time. The Fitness For Kids Camp Director reserves the right to cancel the enrollment or dismiss any camper whose behavior or conduct is deemed disruptive to the Fitness For Kids Camp, it’s goals or objectives. Tuition is based on a five-day calendar week. There is no mixing, matching, or combining of days from different weeks to create “one week”. There is no refund or credit for days missed.
Camper’s Name: Parent/Guardian Name:
Date: Parent/Guardian Signature: ______________
Payment Policy
The Fitness For Kids Camp is a pre-pay program. A complete payment schedule will be provided to parents. Please make note of these deadlines and understand that your cooperation and timely payment allows us to plan appropriately for the needs of the children.
Returned Check Policy
Any check that is returned to us for insufficient funds or stop payment must be paid with a $30 service charge in cash or money order by the close of the next business day. Once a check has been returned to us, all remaining payments must be made by cash or money order.
Camp T-Shirts
For the safety of your child(ren), he/she must wear a camp t-shirt every day. In the event that your child does not wear their camp shirt, a shirt will be given to them and a $12 fee will be charged to the parent’s account.
Late Pick-Up Policy and Charges
The Fitness For Kids Camp finishes at 4:00 p.m. daily. Pick up time is between 4:00pm-6:00 p.m. at no additional charge.
Late charges: Any time a child is not picked up by 6:00 p.m., there will be a late charge of $5.00
for each child for every ten-minute increment. (Example: at 6:20 p.m., the charge will be $10.00 per child.) This policy will be strictly adhered to in fairness to all.
I understand the preceding policies of the Fitness For Kids Summer Camp Program. Parent/Guardian Signature________________________ Date:
FITNESS FOR KIDS, INC. PARENTAL CONSENT WAIVER AND RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT
Program Name: Dates: Fitness For Kids Summer Camp June 9, 2008 – August 1, 2008
FOR GOOD AND VALUABLE CONSIDERATION, including permission for (the “minor”) to participate in FITNESS FOR KIDS SUMMER CAMP and related activities, I, the parent/guardian of the minor for myself and on behalf of the minor: 1. Consent to the minor’s participating in the event or activity; and agree that prior to the minor’s participation in the event or activity; 2. Release, waive discharge and relinquish FITNESS FOR KIDS, INC., The Ridges, HOA, Gables Property Management, Inc., and their officers, employees, and agents from any liability, loss, damage, claim, demand or cause of action against the attributable to the minor’s participation in the event or activity, whether same shall arise by their negligence or otherwise; 3. Assume any and all risks of personal injuries to the minor and authorize FITNESS FOR KIDS, INC., to contact or employ a licensed physician to render any medical treatment that may be deemed necessary for the minor or to take and admit the minor to any hospital. If such medical treatment or hospitalization is required, I agree to pay all medical and hospital bills relating thereto, permanent or partial disability, or death and damages to the minor’s or my property, caused by or arising from the minor’s participation in the event or activity; 4. Covenant not to sue or present any claim for personal injury, property damage, or wrongful death for or on behalf of the minor against FITNESS FOR KIDS, INC., The Ridges, HOA, Gables Property Management, Inc., and their officers, employees, and agents attributable to the minor’s participation in the event or activity; 5. Agree that photographs, pictures, slides, or videos of the minor may be taken in connection with the minor’s participation in the event or activity without compensation from FITNESS FOR KIDS, INC., and consent to the use of photographs, pictures, slides, movies, or videos for any legal purpose; 6. Warrant that the minor is in good health and has had no physical condition that would prevent the minor from participation in the event or activity; IMPORTANT: THIS DOCUMENT RELIEVES FITNESS FOR KIDS, INC., AND OTHERS FROM LIABLITY FOR PERSONAL INJURY, WRONGFUL DEATH, AND PROPERTY DAMAGE CAUSED BYNEGLIGENCE. I HAVE READ THIS DOCUMENT, UNDERSTAND THAT I WILL GIVE UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN VOLUNTARILY. PRINTED NAMES (Parent/Guardian) SIGNATURES DATE
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