Camp Edge 2008 Registration Form

Mail registration form to: Sports & Fitness Edge of Williston
Attn: Bob Hunt
115 Wellness Drive, Williston, Vt. 05495


Parent/Guardian Name
Last:
First:
Address/City/Zip:
Phone
Home:
Work:
Cell:
Emergency contact person and phone number:


Child 1Child 2Child 3
Name

Age and DOB

Grade completed 6/2008

Allergies

Medications

Swim Level

Membership Status

Ultimate Edge Member
Non-Member		 Ultimate Edge Member
Non-Member		Ultimate Edge Member
Non-Member


NUMBER OF DAYS: (check one)     ____ 2 days     ____ 3 days     ____ 4 days     ____ 5 days

Circle days:       Mon       Tue       Wed       Thu       Fri       CAMP EDGE HOURS: 12:30 - 5:30pm

CAMP SESSIONS:
(check all that apply)		 _____ Session 1: June 23 - June 27 _____ Session 5: July 28 - Aug 1
_____ Session 2: June 30 - July 2 (no 4th) _____ Session 6: Aug 4 - Aug 8
_____ Session 3: July 7 - July 11 _____ Session 7: Aug 11 - Aug 15
_____ Session 4: July 14 - July 18 _____ Session 8: Aug 18 - Aug 22


WEEKLY RATES:5 Day4 Day3 Day2 Day
Member:$100$90$75$50
Non-member$110$95$80$60


PAYMENT INFORMATION: All deposits and payments are non-refundable.

______ Check - Please make checks payable to Sports & Fitness Edge of Williston

______ MC/VISA Card #_______________________________Exp. ______

Total amount due for summer: __________ Signature: __________________________________________

Once camp begins June23, 2008 you are responsible for payment of the schedule you committed to do on the registration form. Any changes to your schedule must be made prior to June 23, 2008.

$50 deposit per child due now: _________________ Balance Due Day One: ________________

Parent/Guardian Signature: ___________________________________ Date: ________________

 

Camp Edge Health and Permission Form

Mother's Name ________________ (home) ______________ (work) _____________ (cell) _____________

     Place of Employment __________________________________________

Father's Name _________________ (home) ______________ (work) _____________ (cell) _____________

      Place of Employment __________________________________________

If Parent/Guardian cannot be reached, call: ____________________________ (phone) _______________

      Or, call: _____________________________ (phone) _____________________

Physician's Name: _________________________________ (phone) _______________________

Hospital Preference: _______________________________________________________________

Dentist's Name: ___________________________________ (phone) _________________________

Medical Insurance Company: _______________________________ Policy Number _________________________


Indicate any serious medical conditions (allergies, recurring illnesses, disabilities, chronic illnesses, etc.)

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Allergic to: ___________________________________________________________________________

List the names of any medications applicant is presently taking and for what medical conditions:

_____________________________________________________________________________________________

_____________________________________________________________________________________________

Date of most recent tetanus immunization: _____________________________________

I give permission for my child to participate in all the Sports & Fitness Edge on and off site activities during the camp. I agree that in case of an accident involving my child while attending this camp, I release the Sports & Fitness Edge employees and volunteers from any and all liability caused by claims from injury or damage my child may have sustained from use of premises or equipment while participating in any camp activity.
  I give permission for camp staff to administer bug spray and suntan lotion to my child during camp. I also give permission for camp staff to document campers through photographs of campers participating in sports, crafts and camp life.
  The Sports & Fitness Edge has adopted the following procedures in caring for your child when he/she becomes sick or injured while attending camp: (1) The camp will call home. If there is no answer (2) the camp will call the mother's, father's or guardian's place or employment. If there is no answer, (3) the camp will call the other phone numbers listed and the physician. If none of the above answer, the camp will call an ambulance, if necessary, to transport the child to a local medical facility. (4) Based on the medical judgment of the attending physician, the child may be admitted to a medical facility. (6) The camp will continue to call the parent or guardian until one is reached. If the camp authorities follow the procedure I agree to assume all expenses for moving and medically treating the camper. I also hereby consent to any treatment, which may be carried out based on the medical judgment of the attending physician.
  In case of an emergency, I give permission to the appropriate personnel to properly transport my child to a medical facility for care. I understand that Sports & Fitness Edge DOES NOT provide medical insurance and that I will be responsible for all medical expenses incurred.
  I understand that if my child needs adult assistance/aid during his/her school day then he/she may not attend camp without the same assistance. This assistance must be provided by the parent or school system; Sports & Fitness Edge is not responsible for hiring or providing compensation for additional staff needed for an individual child. For questions or specific situations please talk directly to the director.


Parent/Guardian Signature: __________________________ Date: ______________________