SLAM Sports Summer Camp Parent & Camper Handbook/Manual 2014
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SLAM SPORTS Summer Camp Enrollment/Registration Form Summer of 2014 Participant s Full Name (Last) (First) (Middle In.) Date of Birth: Age: Sex: Grade: Address: City: State: Zip: Siblings in the camp: No Yes How many: *Office use only Sibling Names: Please include a picture of your child with this application Camper # Group Swim T-Shirt Size: Circle one YXS (youth extra small) YS (youth small) YM (youth medium) YL (youth Large) AS (Adult small) AM (Adult Medium) (One T-Shirt will be included with the registration fee. Additional T-Shirts are available for a cost of $12 per T-Shirt) Mother s Name: Home #: Place of Employment: Work #: _ Cell #: Email Address: (required for Camp communications) Father s Name: Home #: Place of Employment: Work #: Cell #: _ Email Address: (required for Camp Communications) Emergency Contact Name (other than parent): Contact #: Doctor s Name: Doctor s #: Doctor s Address: Insurance Company: Policy #: _ Medical Needs (Allergies)/Other Special Needs/Medications:
Please Circle Weeks the camper(s) will be attending: Week 1: June 9 June 13 Week 2: June 16 June 20 Week 3: June 23 June 27 Week 4: June 30 July 3* Week 5: July 7 July 11 Week 6: July 14 July 18 Week 7: July 21 July 25 Week 8: July 28 August 1 *July 4 th is a Holiday. Camp will be closed. Persons Authorized to Pick Up (Please know that all persons picking up MUST have proper ID): 1. (Relationship) Phone: 2. (Relationship) Phone: 3. (Relationship) Phone: 4. (Relationship) Phone: 5. (Relationship) Phone: Persons NOT- Authorized to Pick Up: RELEASE: In case of medical emergency, I hereby give permission to the physician selected by Mater Academy to order x-rays, routine tests and treatment for the health of my child. In the event I cannot be reached in an emergency, I give permission to the physician selected by SLAM Charter to hospitalize, secure proper treatment for, and to order injection and/or surgery for my child as named above. I understand my personal insurance bears responsibility in case of an accident. Furthermore, I, the undersigned, accept all risk incidentals to SLAM Charter activities and do hereby release SLAM Charter, its officers and its representatives, from all liabilities deriving from pursuits of said activities by my child. It is further agreed that SLAM Charter assumes no responsibility for loss of participant s personal property. I give permission for my child to participate in activities. I also give permission to SLAM Charter to use any pictures taken of my child for future promotion purposes. Any photographs taken of the campers by Camp Staff are used for editorial and/or promotional use only. I agree to pay in full all fees prior to participation in this program. I have read, understood, and agree to abide by the entire SLAM Summer Camp enrollment policies, rules, regulations, procedures, payments, and schedules. Print Name: Signature: Date:
Please include a color picture of your child with the submission of this form. SLAM Sports Summer Camp Fee Schedule Payment Due Date Service Period (5 Days) PAYMENTS ARE NON-REFUNDABLE NO EXCEPTIONS No Partial Payments Tuition (9:00 a.m. 4:00 p.m.) June 9 th, 2014 6/09/14 6/13/14 June 16 th, 2014 6/16/14 06/20/14 June 23 rd, 2014 6/23/14 06/27/14 June 30 th, 2014 6/30/14 7/03/14 (4 Days) July 7 th, 2014 7/07/14 7/11/14 July 14 th, 2014 7/14/14 7/18/14 July 21 st, 2014 7/21/14 7/26/14 July 28 th, 2014 7/28/14 8/01/14 $90.00 $75.00 per week per child for two or more siblings. * *Discounts Available upon registration* If signed up 2 weeks at a time it will be $110.00 a week. If signed up 3 weeks at a time it will be $100.00 a week. If signed up 4 weeks at a time it will be $90.00 a week. If signed up 5 weeks at a time it will be $80.00 a week. Registration Fee of 40.00 (non-refundable) for all students registering. If payment is not received by the last day of the current payment period, your child will be dropped from the program and there will be a re-registration fee of $50.00. We reserve the right to withdraw any student who has not paid fees without notification. A late payment fee of $20.00 will be charged for payments not received by the payment due date listed above. NO EXCEPTIONS.
RELEASE OF LIABILITY, WAIVER OF CLAIMS, EXPRESS ASSUMPTION OF RISKS, AND HOLD HARMLESS AGREEMENT In consideration of my child,, Student participating in the Summer Sports Camp at SLAM hosted by Sports Leadership and Management Foundation, Inc, for Sports Leadership and Management Charter Middle/High School School, to wit: athletic activities, events and/or practices including travel to and from same provided by private carpool vehicles, school vehicles, and/or student vehicles on or about June 9, 2014 August 1, 2014 (the Camp ), on such dates, times, and locations as described on the Schedule of Events attached hereto as Exhibit A, and incorporated herein by reference, I, the undersigned parent/legal guardian of Student and the undersigned Student, do hereby agree as follows: I, for myself, my estate, heirs, administrators, executors, and assigns, and for Student, Student s estate, heirs, administrators, executors, and assigns, hereby release and hold harmless the Sports Leadership and Management Foundation, Inc, Sports Leadership and Management Charter Middle/High School, and their officers, directors, employees, representatives, agents, volunteers, and the Camp instructors, employees, representatives, volunteers, agents and assigns (collectively, the Releasees ), from any and all liability and responsibility whatsoever, however caused, for any and all damages, claims, or causes of action that I, my estate, heirs, administrators, executors, or assigns, and/or Student, Student s estate, heirs, administrators, executors, and assigns may have for any loss, illness, personal injury, death, or property damage arising out of, connected with, or in any manner pertaining to the Camp, whether caused by the negligence of Releasees or otherwise. I fully understand that there are potential risks and hazards associated with the Camp and its related travel, including, but not limited to, possible property damage, possible injury or loss of life. I further understand that while participating in the Camp, I and/or Student may be interacting with persons that are not associated with or under the control or supervision of the Releasees. Despite the potential risks and hazards associated with the Camp, I wish to proceed and hereby grant permission for Student to proceed, and freely accept and assume all risks and hazards that may arise from my and/or Students participation in the Camp and that could result in loss, illness, personal injury, death, or property damage, whether caused by the negligence of Releasees or otherwise. The undersigned Parent(s)/guardian(s) of Student and the undersigned Student further agree to comply with all applicable laws and ordinances and School regulations, rules and policies. The undersigned Parent(s)/guardian(s) of Student and the undersigned Student further hereby agree to indemnify and hold harmless the Releasees from any judgment, settlement, loss, liability, damage, costs or expenses, including court costs and attorney fees for both the trial and appellate levels which may be incurred arising out of or in any way related to the Camp or my and/or Student s participation therein, whether caused by the negligence of the released parties or otherwise. In signing this agreement, I acknowledge and represent that I have read and understand it and that I sign it voluntarily and for full and adequate consideration, fully intending to be bound by the same. I HAVE READ THIS AGREEMENT, UNDERSTAND THAT I AM GIVING UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND VOLUNTARILY AGREE TO BE BOUND BY IT. Dated this day of, 20. Name of Participant/Student Printed Name of Parent/Guardian Printed name of Parent/Guardian Participant/Student s Signature Parent/Guardian s Signature Parent/Guardian s Signature