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					                 CAMPER’S NAME: ______________________________
                                   GRADE IN FALL 2011: ________




REGISTRATION
   PACKET
           COMPLETE PAGES 1 10
LIMITED ENROLLMENT RETURN PACKET EARLY
    THIS PACKET MUST BE FILLED OUT & RETURNED

            SUMMER CAMP REGISTRATION CHECKLIST
■    FilloutAllaireCountryDaySummerCamp Schedule Form                                           Page1
     fortheentiresummer.(Minimumof10dayenrollment)
■    FilloutSummerCampRegistration Form                                                           Page2
■    SigntheSummerCampTuition Agreement Form                                                      Page3
■    FilloutEmergency Contact & Authorization Pick-up Form                                          Page4
■    FilloutEmergency Treatment Form                                                                Page5
■    SigntheExpulsion Policy Form                                                                   Page6
■    SignthePhotography Consent Form                                                                Page7
■    FilloutHealth Release Form                                                                     Page8
■    FilloutSummerCampSpecial Events Registration Form                                     Page9&10
     (Page9:SelectEvents and Page10:SpecialEventWaiver)


■    PaytheRegistration Fee No.children____X$50
     ($100maximumregistrationperfamily-3rdand4thchildfree)
■    PaytheSummerCampTuition Fee. Eitherpaythetuitioninfullorpayadeposit.
     DEPOSITREQUIRED:Minimumof20%oftuition &specialeventspaidinfull.

                                Early Bird Discount 10% OFF Tuition
             Ifpaidinfullonorbeforeopenhouse-Saturday,March26th11am-2pm
                               (Discountonlyavailableforgold&silvertuitionpackages)

                      • NO Refunds
                      • Registration Fee: $50PERCHILD.$100Maximumregistrationperfamily.
                        (3rdand4thchildfree)AllchildrenMUSTresideatthesameaddress!
                      •   Late Fee: Anyfeepaidaftertheduedatewillrequirea$15LateFeetobepaid.
                      •   Change of Schedule Fee: Allschedulechangesmustbemade2weeksin
                          advance.Ifmorethan3campchangesoccurperfamily,a$15feewillapplyper
                          additionalchange.
                      •   ALL CHANGES MUST BE MADE IN WRITING.
                      •   Required Deposit: Minimum20%oftuition,registrationfee(s)andany
                                            specialevents mustbepaidinfull
                                                                                                                                    PAGE 1
                                  Allaire Country Day Summer Camp
                                   SCHEDULE FORM
    CampersFullName:(PleasePRINTClearly)                                               D.O.B.                         GradeinSept.2011




2011 SUMMER CAMP DAILy RATES                                                      9:00am - 4:00pm

CAMPERS 4-13 yEARS                                    TODDLERS 2          1/2   - 3 yEARS                        Before & After Care
Package             No. of Days       Daily Rate      Toddler Packages            No. of Days   Daily Rate       BeforeCare 7:00-9:00am
                                                      ■ TODDLERGOLD                 41-49    $50              AfterCare 4:00-6:00pm
■ GOLD             41-49            $40
                                                      ■ TODDLERSILVER               21-40    $55              $7perhour -perchild
■ SILVER           21-40            $45
                                                      ■ TODDLERBRONZE 10-20                  $60              $10perhour-perfamily
■ BRONZE           10-20            $50
                    You must select a package level for your camper - check box above.                           *Refertopage3fordetails
    Any extra days added to your child’s schedule are subject to the originally selected package pricing.
                                  Please check each box for ALL camp days your child is attending .                                 Internal
                                  Circle Before Care (BC) and/or After Care (AC) on the days that apply.                             UseONLY

    Week#    Dates                   MON                 TUE                   WED             THUR                   FRI          Amt Due
                                               BC                 BC                   BC                   BC                 BC
    1         June20-24                       AC                 AC                   AC                   AC                 AC   $
                                               BC                 BC                   BC                   BC                 BC
    2         June27-July1                   AC                 AC                   AC                   AC                 AC   $
                                    4TH OF JULy                   BC                   BC                   BC                 BC
    3         July4-8             CLOSED                         AC                   AC                   AC                 AC   $
                                               BC                 BC                   BC                   BC                 BC
    4         July11-15                       AC                 AC                   AC                   AC                 AC   $
                                               BC                 BC                   BC                   BC                 BC
    5         July18-22                       AC                 AC                   AC                   AC                 AC   $
                                               BC                 BC                   BC                   BC                 BC
    6         July25-29                       AC                 AC                   AC                   AC                 AC   $
                                               BC                 BC                   BC                   BC                 BC
    7         Aug1-5                          AC                 AC                   AC                   AC                 AC   $
                                               BC                 BC                   BC                   BC                 BC
    8         Aug8-12                         AC                 AC                   AC                   AC                 AC   $
                                               BC                 BC                   BC                   BC                 BC
    9         Aug15-19                        AC                 AC                   AC                   AC                 AC   $
                                               BC                 BC                   BC                   BC                 BC
    10        Aug22-26                        AC                 AC                   AC                   AC                 AC   $

                                                                                                                       Discounts    $
• Registration Fee: $50PERCHILD.$100Maximumregistrationperfamily.
 (3rd,4th,etc.childrenfree)AllchildrenMUSTresideatthesameaddress!
• Late Fee: Paymentsmademorethan15daysafterduedaterequirea$15fee
                                                                                                                 RegistrationFee   $
• Registration Requirements: PleaseseeregistrationInfoform.
• Change of Schedule Fee: Allschedulechangesmustbemade2weeksinadvance.                             SpecialEventFees    $
 Ifmorethan3campchangesoccurperfamily,a$15feewillapplyperadditionalchange.
• ALL CHANGES MUST BE MADE IN WRITING.                                                                               DEPOSIT        $
• Required Deposit: Minimumof20%oftuition
• NO Refunds                                                                                                       BALANCE          $
                                                                                                                                                                   PAGE 2
                                        Allaire Country Day Summer Camp
                                        REGISTRATION FORM




                                                                                                                                                                                        COMPLETED FORMS & DEPOSIT ARE REqUIRED TO REGISTER yOUR CAMPER
Camper’sName__________________________________________________Gender___________________________


DOB________________________________________Age__________GradeinSept.2011_____________________

HomeAddress________________________________________________Phone______________________________

City/State/Zip______________________________________________________________________________________

Email____________________________________________________________________________________________

1.Parent/Guardian________________________________________RelationshiptoChild________________________
   CellPhone_____________________WorkPhone_____________________HomePhone_____________________

2.Parent/Guardian________________________________________RelationshiptoChild________________________
   CellPhone_____________________WorkPhone_____________________HomePhone_____________________


     A20%deposit,creditcardtoholdonfile andacompletedsummercampregistrationpacketis
   requiredtoregisteryourchildforsummercamp.RegisterEarly!AllbalancesMUSTbepaidinfull
          priortothestartofeachnew2weekbillingcycle.NOREFUNDSWILLBEGIVEN.
                                Please Read Carefully and sign the following Registration-Understanding/Waiver.
InconsiderationforbeingallowedtoparticipateinanywayinALLAIRECOUNTRYDAYSUMMERCAMP athletic/sportsprograms,andrelatedevents,Itheundersignedvolun-
tarilyagreetoassumefullandcompleteresponsibilityforanyinjuryoraccidentwhichmayoccurtotheabovenamedchildduringorinconnectionwithALLAIRECOUNTRY
DAYSUMMERCAMP,GoodSportsUSA,Inc.orit’sstaffwhilethey/IamonthepremisesofALLAIRECOUNTRYDAYSUMMERCAMP.IacknowledgethatatALLAIRECOUN-
TRYDAYSUMMERCAMP,I/theywillparticipateinactivitiesthatmayinvolve,amongotherthings,physicalcontactwithpersonsorobjects,includingtheground,andmayincur
ariskofinjury.Ispecificallywaive,giveupandreleaseALLAIRECOUNTRYDAYSUMMERCAMP anditsstaff,fromallliabilityforanyclaimfordamageswhichI/theabove
namedchildmayhaverelatingtoinjuriesorillnessthatI/theymaysustain.Insigningthiswaiver,IcertifythatI/theabovechildareingoodhealth,withnochronicillnessor
abnormaltendencies.IntheeventofanemergencyinwhichI/theabovechildrequiresmedicalcare,IauthorizeALLAIRECOUNTRYDAYSUMMERCAMP toactformeand
obtainwhatevermedical,surgicalordentalexamination,diagnosisand/ortreatmentisdeemednecessary.ALLAIRECOUNTRYDAYSUMMERCAMP isnotresponsibleformy
personalbelongingswhicharelost,stolen,ordamaged.IfurtherunderstandthatIshouldbeawareofmy/theabovenamedchild’sphysicallimitationsandagreenottoexceed
them.IagreetoreviewtherulesandinspectthefacilitiesandifIbelieveitisunsafeIwilladvisehisorhercounselor andrefusetoparticipate.IUNDERSTANDTHEALLAIRE
COUNTRYDAYSUMMERCAMPWAIVERPOLICY.


         Sign:______________________________________PrintName:_______________________________________

CREDIT CARD MUST BE KEPT ON FILE
■ CASH■ CHECK■ CREDIT CARD:CARDTYPE■ Visa■ MC■ Discover
Card#____________________________________Exp.Date:_________SignatureonCard:__________________________

CAMP POLICIES:
• NO refunds
• NO refunds for missed camp days. Payment is due whether or not your child attends camp, unless there is a
   medical emergency and a doctor’s note is provided.
• If more than 3 camp changes occur per family, a $15 fee will apply to any additional changes made.
I understand the Allaire Country Day Summer Camp payment policy. I authorize Allaire Country Day to
charge my credit card for any additional fees, and/or outstanding balances.

Sign:______________________________________PrintName:_______________________________________

                                            All medical forms, registration, and schedule forms MUST
                                            be filled out completely and submitted with your payment.
                                                                                                                 PAGE 3
                         Allaire Country Day Summer Camp
                         TUITION AGREEMENT
      Iunderstandthetuitionisdueandnochangesorsubstitutionsinschedulecanbemaderegardlessofthefollow-
      ingcircumstances:
      1.Ifmychildisabsentduetoillness
      2.Mychildisabsentduetovacation
      3.Aholidayfallsonmychild’sscheduledday
      4.Delayedopenings/earlyclosingsduetounforeseenweatherconditions
         orcircumstancesbeyondourcontrol.
      5.Mychildisabsentduetoanyotherreason

      CAMP POLICIES:
      •NOREFUNDS
      •NOrefundsformissedcampdays.Paymentisduewhetherornotyourchildattendscamp,
        unlessthereisamedicalemergencyandadoctor’snoteisprovided.
      •$40returnedcheckfee.
      •Atthetimeofregistrationyoumustpayaminimumof20%ofyourtuition,registrationfees
        andallspecialeventfees.
      • Specialeventsmustbepaidforinfullattimeofregistration-spotsarelimited.
      •ContractedBilling-Daysyouscheduledyourchildtoattendwillbebilledbi-weeklyinadvance.
      •ActualBilling-Daysyourchildattendedbutwas notscheduledwillbebilledbi-weeklyforthe
         previous2weeksattendancealongwithanybeforecareand/oraftercare.
      •$15schedulechangefeeifmorethan3changesoccurperfamily.
      •Allschedulechangesmustbemade2weeksinadvanceinwriting.
      •Anyextradaysaddedtoyourchild’sschedulearesubjecttotheoriginalpackagepricing.
      •Allpaymentsaredueuponreceipt.
      •Anybalanceover15dayswillbeconsideredlateandsubjecttoa$15.00latefeeandwillbe
        chargedtothecreditcardonfile.
      •Sign-in/Sign-outinstructionswillbegiventoyoupriortothestartofcampwithawelcomeletter.
      •Allbillinginvoiceswillbesentautomaticallyviae-mail.
        PleasebesuretoprovideavalidemailaddressontheRegistrationForm.
      •Paperstatementswillbeavailableuponrequest.
      •Anybillingquestionsshouldbedirectedtotheaccountingdepartmentat732-681-8898.
      BEFORE/AFTERCAREPOLICY
      • Campstartsat9am,ifyouarriveearlyyoucanmakeuseofourbeforecareservice;
         otherwise,youmuststaywithyourchilduntil9am.
      • Campendsat4pm,ifyourchildisnotpickedupbythentheywillbeplacedinouraftercareprogram.
      • Ifyourchildisdroppedoffbefore9:00amorpickedupafter4:00pmyouraccount willbeautomatically
         billedfortheBC/ACrates.
      • Youwillbechargedaminimumof1hour.Ifyourchildishereafterthe1sthour,youwillbebilledforthe2nd.
      • IfuseofBC/AC occursmorethan3timeswithoutwrittennotificationyouwillbechargeda$20fee.
      • Ifyourchild(ren)isnotpickedupby6pmyouwillbechargeda$20feeperchildperhour.

By choosing one of the daily pricing packages (gold, silver, bronze) on the attached “schedule form”, I
acknowledge responsibility for payment for at least the minimum days of that package.
I understand the Allaire Country Day Summer Camp payment policy. I authorize Allaire Country Day to
charge my credit card for any additional fees, and/or outstanding balances.


     Sign:______________________________________PrintName:_______________________________________


              Ifyouchoosetomailyourpayments,pleasesendtothefollowingaddress:
                AllaireCountryDaySummerCamp,2903Highway138,Wall,NJ07719
                            Allaire Country Day Summer Camp                                                       PAGE 4

                        EMERGENCy CONTACT
                         & AUTHORIzED PICK-UP
I authorize the following people to pick up my child from Allaire Country Day. All others MUST
present a written request from me for my child to be discharged into their hands, and such in
writing absolves Allaire Country Day from responsibility after the child leaves the school. All
written requests will remain on file at the school. Allaire Country Day has the right to verify iden-
tification by asking for proof, such as a drivers license.
Parent/GuardianSignature:___________________________________________________Date:______________________

                 EMERGENCy CONTACT/PICK-UPS - MUST BE 18 yEARS OR OLDER
                                (only 2 contacts required)

1) ContactName __________________________________                  RelationshiptoChild _________________________
Address____________________________________________________________________________________
Phone:Home ___________________ Cell ____________________________ Work_______________________
PLEASECIRCLE YES OR NO              EmergencyContact:YesNo AuthorizedPick-Up:YesNo


2) ContactName __________________________________                  RelationshiptoChild _________________________
Address____________________________________________________________________________________
Phone:Home ___________________ Cell ____________________________ Work_______________________
PLEASECIRCLE YES OR NO              EmergencyContact:YesNo AuthorizedPick-Up:YesNo


Optional: 3) ContactName __________________________                RelationshiptoChild _________________________
Address____________________________________________________________________________________
Phone:Home ___________________ Cell ____________________________ Work_______________________
PLEASECIRCLE YES OR NO              EmergencyContact:YesNo AuthorizedPick-Up:YesNo


Optional: 4) ContactName __________________________                RelationshiptoChild _________________________
Address____________________________________________________________________________________
Phone:Home ___________________ Cell ____________________________ Work_______________________
PLEASECIRCLE YES OR NO              EmergencyContact:YesNo AuthorizedPick-Up:YesNo


Optional: 5) ContactName __________________________                RelationshiptoChild _________________________
Address____________________________________________________________________________________
Phone:Home ___________________ Cell ____________________________ Work_______________________
PLEASECIRCLE YES OR NO              EmergencyContact:YesNo AuthorizedPick-Up:YesNo
                                          Allaire Country Day Summer Camp                                                           PAGE 5

                                       AUTHORIzATION FOR
                                       EMERGENCy TREATMENT
CAMPER’S INFORMATION:
Camper’sName ___________________________________________________                      SocialSecurity#___________________________________________
Child’sStreetAddress ______________________________________________                  City/State/Zip _____________________________________________
Phone ______________________ DateofBirth___/___/___Age________Gender:■ Male■ Female


MEDICAL INFORMATION:
Stateanymedicalproblems:(Ifnonecheckhere■ ) _________________________________________________________________________________
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________

Allergiestomedicine,food,insects,animals,etc:(Ifnonecheckhere■ ) _________________________________________________________________
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
Listanyandallmedicationsyourchildistaking:(Ifnonecheckhere■ ) _________________________________________________________________
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________


PHySICIAN/INSURANCE INFORMATION:
Physician’sName __________________________________________________                    Phone ___________________________________________________
Address _____________________________________________________________________________________________________________________
InsuranceCarrier __________________________________________________                   Phone ___________________________________________________
Address_____________________________________ID#_____________________Policy#_____________________Group#
_____________________


ADDITIONAL INFORMATION yOU FEEL IS NECESSARy: _______________________________________________
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
BYSIGNINGBELOW
I statethatI theparent/guardianhave legalcustodyoftheabovechildandattestthattheinformationaboveiscorrect.I authorizetheAllaire
CountryDayCampDirectororDirector’sdesigneetoobtainemergencytreatmentformychild.Iconsenttoanx-rayexamination,anesthetic,
medicalorsurgicaldiagnosisortreatment,andhospitalcaretoberenderedtotheminoratarecognizedmedicalfacility,underthegeneralor
specialsupervisionofalicensedphysicianorsurgeon.

THEFOLLOWINGSTEPSWILLBEFOLLOWEDINANEMERGENCY:
1.TheParent/Guardianwillbecontactedimmediately
2.Thechild’sphysicianwillbecontacted
3.Wewillattempttocontactyouthroughallemergencypersonslistedonthechild’sapplicationform
4.Ifwecannotcontactyouoryourchild’sphysicianwewilldoanyofthefollowing:
      a.Callforemergencyfirstaid
      b.Callanotherphysician
      c.Havethechildtransportedtoanemergencyhospitalinthecompanyofastaffmember.


_____________________________________________________________
 SignatureofParent/Guardian                        Date
                                                                                       PAGE 6
           Allaire Country Day Summer Camp
                ExPULSION POLICy

Unfortunately,therearesometimesreasonswehavetoexpelachildfromour
programeitheronshorttermorapermanentbasis.Wewantyoutoknowwe
willdoeverythingpossibletoworkwiththefamilyofthechild(ren)inorderto
prevent this policy from being enforced. The following are reasons we may
havetoterminateorsuspendachildfromthiscenter.

I. PARENTAL ACTIONS FOR CHILD’S ExPULSION
• Failure to pay and/or habitual lateness in payments
• Failure to complete required forms including immunization records
• Physical and/or verbal abuse to staff

II. CHILD’S ACTIONS FOR ExPULSION
   The camp reserves the right to dismiss any camper who’s condition,
   conduct, influence or behavior is deemed unsatisfactory or detrimental to
   the best interest of the camp, staff or fellow campers.

Allaire Country Day reserves the right to expel a child at any point.
No refunds will be issued.

NameofCenter:Allaire Country Day

NameofChild:____________________________________

Parent/GuardianSignature:____________________________________

Date:_______________
                                                                                     PAGE 7
           Allaire Country Day Summer Camp
        PHOTOGRAPHy CONSENT

Thisformwillgivemypermissionformychildtobephotographedunderthe
followingconditionswhiletheyareacamperatAllaireCountryDay.Iunder-
standthatthisisthepolicyofAllaireCountryDaythatunlessexpresslypermit-
tedbyaparentatthetimeaphotographisusedorprintedthatthenamesof
childrenwillNEVERbeassociatedwiththeirphotograph.


1.Insertioninthecampphotoalbum                        ___Yes___No
2.Campprojectstobesenthome                            ___Yes___No
3.Possibleuseinfuturecampbrochures                    ___Yes___No
4.Newsreleases                                            ___Yes___No
5.NewspaperAdvertisements                                 ___Yes___No




NameofChild:____________________________________

Parent/GuardianSignature:____________________________________

Date:_______________
                                  PAGE 8
Allaire Country Day Summer Camp
HEALTH RELEASE FORM
                                Allaire Country Day Summer Camp                                                     PAGE 9

                                SPECIAL EvENTS
                                Pre-K thru 8th Grade Registration                                    (min. 4 years old)

 CAMPER’SNAME____________________________________AGE___________GRADEINFALL2011 _________
 ADDRESS_________________________________________________PHONE_____________________________
 EVENT                      LOCATION       DAY         DATE      TIME          GRADE      LUNCH            WAIVER   FEE   TOTAL

 FunBus                    Goodsports     Tuesday     6/28/11   10:00-12:00   PreK-K     No                        $10

 AspiringArtist            Goodsports     Friday      7/1/11    1:00-2:00     PreK-K     No                        $5

 Zumba                      Goodsports     Tuesday     7/5/11    11:00-12:30   4th-8th    No                        $5
 BlueClaws                 Lakewood       Wednesday   7/6/11    10:00-3:00    1st-8th    HotDog                   $27

 Junglerrrific              Oakhurst       Thursday    7/7/11    9:00-12:30    PreK-K     No                        $20

 Surfing                    Belmar         Friday      7/8/11    TBA           4th-8th    No               YES      $35

 Kayaking                   Belmar         Monday      7/11/11   TBA           4th-8th    No               YES      $35

 HouseofBounce            Wall           Tuesday     7/12/11   9:30-12:30    PreK-3rd   Pizza                     $25

 SandCastleContest        Belmar         Wednesday   7/13/11   9:30-12:00    PreK-8th   No                        $15

 Bowling                    SeaGirt       Friday      7/15/11   10:00-1:00    PreK-8th   Pizza                     $23

 LizardGuy                 Goodsports     Monday      7/18/11   11:00-12:30   PreK-8th   No                        $5

 Zumba                      Goodsports     Tuesday     7/19/11   11:00-12:30   PreK-3rd   No                        $5

 BlueClaws                 Lakewood       Wednesday   7/20/11   10:00-3:00    1st-8th    HotDog                   $27

 CombatSports              Manalapan      Friday      7/22/11   8:30-1:00     4th-8th    Pizza            YES      $38

 Surfing                    Belmar         Monday      7/25/11   TBA           4th-8th    No               YES      $35

 AllaireStatePark         Wall           Tuesday     7/26/11   10:00-2:00    PreK-2nd BringBagged                $20

 AspiringArtist            Goodsports     Wednesday   7/27/11   12:30-1:30    1st-3rd    No                        $5
 AspiringArtist            Goodsports     Wednesday   7/27/11   1:30-2:30     4th-8th    No                        $5

 MedievalTimes             Lyndhurst      Thursday    7/28/11   9:30-3:00     4th-8th    Chicken                   $55
 KinderDance               Goodsports     Friday      7/29/11   10:00-12:00   PreK-K     No                        $10

 IceSkating                Wall           Monday      8/1/11    9:00-1:00     1st-8th    Pizza                     $26

 HouseofBounce            Wall           Thursday    8/4/11    9:30-12:30    4th-8th    Pizza                     $25

 Kayaking                   Belmar         Friday      8/5/11    TBA           4th-8th    No               YES      $35

 AspiringArtist            Goodsports     Monday      8/8/11    12:30-1:30    1st-3rd    No                        $5
 AspiringArtist            Goodsports     Monday      8/8/11    1:30-2:30     4th-8th    No                        $5

 Pirates ontheManasquan   Belmar         Tuesday     8/9/11    9:30-3:00     PreK-3rd   No                        $30

 HurricaneHarbor           Jackson        Wednesday   8/10/11   9:30-3:30     3rd-8th    Variety                   $52

 BlackbeardsCave           Bayville       Friday      8/12/11   9:00-2:00     1st-8th    HotDog/Burger            $45

 CombatSports              Manalapan      Monday      8/15/11   8:30-1:00     4th-8th    Pizza            YES      $38

 Jenkinson’sAquarium       Pt.Pleasant   Wednesday   8/17/11   9:30-11:30    PreK-8th   No                        $25

 AspiringArtist            Goodsports     Tuesday     8/23/11   12:30-1:30    1st-3rd    No                        $5
 AspiringArtist            Goodsports     Tuesday     8/23/11   1:30-2:30     4th-8th    No                        $5


                                                                                SPECIALEVENTSTOTAL$_________
(Continued on page 10...)
                       Allaire Country Day Summer Camp                                           PAGE 10

                       SPECIAL EvENTS
                       Pre-K thru 8th Grade                   (min. 4 years old)




(Continued from page 9...)


CAMPER’SNAME____________________________________AGE___________GRADE__________
ADDRESS___________________________________________________________
PHONE(EMERGENCYCONTACT) _________________________________________




     PERMISSION/WAIvER Iherebygivepermissionfortheabove-namedchildtopartici-
     pate inA.C.D. Special Events. By signing below I hereby release and agree to hold
     harmlessGoodSportsUSAandit’sstafftothefullestextentallowedbylawfromany
     andallclaimsforpersonalorbodilyinjuryandpropertydamageoccurringorresulting
     fromtheabovenamedchild’sparticipation.Igivepermissionfortheabovenamedchild
     torideonthebus/vantoanyeventthatisoff-sitefromtheGoodSportsUSAcampus.I
     herebyauthorizetheGoodSportsUSAandAllaireCountryDaystafftoobtainanyneed-
     ed medical assistance for my child in case of an emergency, illness, or accident.  I
     understandthatanyresultingexpensesorchargesaremyresponsibilityandIwillpay
     themimmediately,eitherdirectlyorthroughpersonalinsurance.


     @      _____________________________________________________________
             SignatureofParent/Guardian

            __________________
               Date



•Allspecialeventfeesareinadditiontoexistingregularcampfees
•Eventdays/timessubjecttochange
•Paymentisdueinfullattimeofregistration.
•Inordertoparticipateinany“SpecialEvent”thecamper(s)mustberegisteredforcamp
  onthedateoftheevent aboveandpaidinfull.
•Specialeventfeeslistedarepercamper/perevent.TheseareNOTincludedinregularcampfees.


                                        LIMITED SPOTS AvAILABLE!!
                            2903 Highway 138 • Wall, NJ 07719 • 732-681-4651
                                   www.allairecountryday.com