Date:________
2011 TURKEY CAMP REGISTRATION FORM
451 Defense Highway Annapolis, MD 21401
Phone (410) 224-0721 www.1stClassGym.com
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Child’s Name Last First Gender (F) (M) Age
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Child’s Name Last First Gender (F) (M) Age
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Parent’s Name Last First
Address City State Zip
______________________________________________________________________________________ Telephone(Home) Email Address:
Telephone Mother (Cell & Work) Father (Cell & Work)
EMERGENCY # Alternate
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Notes/Allergies/Medical
Date of Last Physical Exam(s) Date of Tetanus School(s) Attending
Acknowledgement of Risk and Waiver of Liability and Permission to Treat
I hereby give permission for my child/children to participate in classes/events conducted at 1st Class Gymnastics, Inc. I understand that it is my responsibility to carry my own accident and medical insurance. In the event of an injury or accident, I authorize customary medical treatment if it becomes necessary, and transportation and emergency medical services if warranted. The enrolled child/children is/are capable of participating in the sport of gymnastics and have had a physical within the last (12) twelve months. Any activity involving motion, tumbling, height, swinging, etc… involves the possibility of serious, permanent or fatal injury. I understand the risks of participating in the sport of gymnastics and Therefore, in consideration for allowing my child/children to use the 1st Class Gymnastics Training Center’s equipment and facilities, I hereby forever release 1st Class Gymnastics, Inc., it’s owners, officers, employees, teachers and coaches from all liability for any and all damage and injuries suffered by my child/children while under the instruction, supervision or control of 1st Class Gymnastics, Inc., it’s owners, officers, employees, teachers, coaches and booster club. I hereby authorize 1st Class Gymnastics, Inc. to use photographs, videos or electronic likeness of my child in any publication or website promoting or advertising 1st Class Gymnastics, Inc. I do hereby forever release any and all claims against 1st Class Gymnastics, Inc. for the use of any of the video images and photographs as described above. This acknowledgment of risk and waiver of liability, having been read thoroughly and understood completely, is signed voluntarily as to its content and intent.
_______________________________________________________________________Date Printed Name of Parent or Legal Guardian Signature of Parent or Legal Guardian
TURKEY CAMP 2011
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Child’s Name Last First School Gender (F) (M) Age
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Child’s Name Last First School Gender (F) (M) Age
Mini-Gobblers 3 1/2 YRS – 5 YRS Please check # OF DAYS desired
Please check week preferred and circle # OF DAYS each week desired
1 2 3 DAYS
_____Nov 21st – Nov 23rd M T W
(No Camp November 24th or 25th )
Pre-Registered Fees: 1 Day $45, 2 Days $90, 3 Days $135
Camp Hours: 9:00 AM to 2:00 PM
FitKIDZ 5 YRS OLD & OLDER
Please check weeks preferred and circle # OF DAYS each week desired
1 2 3 DAYS
_____Nov 21st – Nov 23rd M T W
(No Camp November 24th or 25th)
Pre-Registered Fees & Options:
3 Days Full Day $150.00 3 Days Half Day $120.00 2 Days Full Day $100.00 2 Days Half Day $ 80.00
1 Day Full Day $ 50.00 1 Day Half Day $ 40.00
Camp Hours: 9:00 AM to 5:00 PM 9:00 AM to 2:00 PM
EARLY MORNING DROP OFF: YES NO M T W Time:_________
LATE PICK UP: YES NO M T W Time:_________ Please circle days desired
$10 PER DAY “DROP IN” FEE FOR CAMPERS NOT PRE-REGISTERED
Early & Late additional fees: $5.00 for half hour $8.00 for each hour
Payments: (DEPOSIT $50 NON-REFUNDABLE-NON TRANSFERABLE PER WK)
OFFICE USE ONLY:
TOTAL AMOUNT DUE _______________ AMT RECD ________CC_______CK#______
BALANCE DUE __________DISC APPLIED ______
Dress Code: Children should wear gym attire, no baggy clothing and girls should wear their hair back. 10 % Discounts for siblings. Payments must be made at registration. No refunds or credits
Rev 03 21 11
