Five Seasons Sports Fun Camp

Registration Form

Member Name:  _________________________________   Member Number:  ____________

Address:  _______________________________________  Phone Number:  ______________

City, State, Zip:  _________________________________  Alternate Phone:  _____________

E-Mail Address:  ______________________________________________________________

Child #1:  ___________________________  Age:  ___________  M/F:  ___________

Child #2:  ___________________________  Age:  ___________  M/F:  ___________

Child #3:  ___________________________  Age:  ___________  M/F:  ___________

Child #4:  ___________________________  Age:  ___________  M/F:  ___________

Please circle the weeks you are signing your child/children up for:

June 9 – 13, June 16 – 20, June 23 – 27, June 30– July 3**, July 7 – 11, July 14 – 18, July 21 –

25, July 28 - August 1, August 4 – 8, August 11-15, August 18-22

Please list any child has any known allergies, special needs or any conditions that need to be known by sports staff:  ______________________________________________________________________________

Emergency Information:

Contact Name:  _______________________  Relationship:  ____________________

Daytime Phone:  ______________________  Evening Phone:  __________________

Cell Phone (Mother):  ___________________  (Father):  ______________________

I certify that my child/children are in good health and have my permission to participate in practice, competition, and special events for the Five Seasons Sports Fun Camp.

It is expressly agreed that all use of Five Seasons Sports Club’s facilities/programs shall be undertaken at the participant’s sole risk, and the Club shall not be liable for injuries or damages to participants or users, including, without limitation, those injuries or damages resulting from acts of active or passive negligence on the part of the Club, its owners, officers, employees or agents.  Each participant, for himself/herself and family members, and on behalf of his/her executors, administrators and assigns, expressly releases, forever discharges and waives any claims against the Club, its successors and assigns, as well as its owners, officers, employees and agents, from all such claims, injuries, damages, actions or causes of action.

Signed:  _________________________________________

Date:  __________________

Fee for this program is $100/wk per child. **$80 for  the week of June 30-July 3.  Program is geared for ages 7-13. 

PLEASE SUBMIT THIS REGISTRATION FORM TO THE MEMBER SERVICES DESK AT LEAST ONE WEEK IN ADVANCE OF SUMMER CAMP.

Maximum enrollment 20 children/wk.