Mailing Address
City, State
Zip Code
Phone Number
Alternate Phone Number
Persons Authorized to Pick Up
(optional)
Emergency Contacts - Name and phone number- someone other than parent - Please list minimum of 2
Child's Name
Date of Birth
(optional)
(optional)
Medical Conditions/Allergies
(optional)
Day Camp Registration
($25.00 extra)
(optional)
Week 1: December 19 - 23, 2016
(optional)
Please select
5 Full Days $220.00
4 Full Days $205.00
3 Full Days $170.00
2 Full Days $140.00
1 Full Day $70.00
5 Half Days $170.00
4 Half Days $160.00
2 Half Days $120.00
3 Half Days $140.00
1 Half Day $60.00
Week 2: December 26 - 30, 2016
(optional)
Please select
5 Full Days $220.00
4 Full Days $205.00
3 Full Days $170.00
2 Full Days $140.00
1 Full Day $70.00
5 Half Days $170.00
4 Half Days $160.00
2 Half Days $120.00
3 Half Days $140.00
1 Half Day $60.00
If choosing a half day option please let us know AM or PM half days. If choosing a 4,3,2 or single day option please let us know which days your child will be attending.
2nd Child's Name
(optional)
Date of Birth
(optional)
(optional)
(optional)
Medical Conditions/Allergies
(optional)
2nd Child Day Camp Registration
($15.00 extra)
(optional)
Week 1: December 19 - 23, 2016
(optional)
Please select
5 Full Days $198.00
4 Full Days $184.50
3 Full Days $153.00
2 Full Days $126.00
1 Full Day $63.00
5 Half Days $153.00
4 Half Days $144.00
3 Half Days $126.00
2 Half Days $108.00
1 Half Day $54.00
Week 2: December 26 - 30, 2016
(optional)
Please select
5 Full Days $198.00
4 Full Days $184.50
3 Full Days $153.00
2 Full Days $126.00
1 Full Day $63.00
5 Half Days $153.00
4 Half Days $144.00
3 Half Days $126.00
2 Half Days $108.00
1 Half Day $54.00
If choosing a half day option please let us know AM or PM half days. If choosing a 4,3,2 day or single day option please let us know which days your child will be attending.
(optional)
3rd Child Day Camp Registration
($15.00 extra)
(optional)
Week 1: December 19 - 23, 2016
(optional)
Please select
5 Full Days $198.00
4 Full Days $184.50
3 Full Days $153.00
2 Full Days $126.00
1 Full Day $63.00
5 Half Days $153.00
4 Half Days $144.00
3 Half Days $126.00
2 Half Days $108.00
1 Half Day $54.00
Week 2: December 26 - 30, 2016
(optional)
Please select
5 Full Days $198.00
4 Full Days $184.50
3 Full Days $153.00
2 Full Days $126.00
1 Full Day $63.00
5 Half Days $153.00
4 Half Days $144.00
3 Half Days $126.00
2 Half Days $108.00
1 Half Day $54.00
If choosing a half day option please let us know AM or PM half days. If choosing a 4,3,2 day or single day option please let us know which days your child will be attending.
(optional)
Snacks and Lunch
Please bring your own food and drinks. Full Day attendees will need a lunch, AM snack and PM snack as wells as drinks. Half Day attendees will need: AM Half day- a snack, lunch and drinks. PM half day will need a snack and drink.
Authorization and Waiver
I hereby authorize the staff of Stars Gymnastics to act for me according to their best judgment in any emergency requiring medical attention & hereby waive & release the staff and Stars Gymnastics from any and all liability for any injuries and illness incurred while at the activity. I understand that participation in gymnastics and various sports activities involves motion and as such carries with it the risk of injury. The facility is not responsible for personal items that are lost, stolen, or damaged. All medical expenses incurred will be the responsibility of the participant’s family. In lieu of medical certificate signed by a medical doctor, I have no knowledge of any physical or mental impairment that would be affected by the named child’s participation in the program. I also understand that Stars Gymnastics retains the right to use any photographs, videotapes, motion picture recordings, or any other record of this event for publicity, advertising, or any legitimate purpose.
E-Signature
