Summer Camps

KIDSPORTS 2009 SUMMER DAY CAMP REGISTRATION

6 FARGO RD, WATERFORD CT 06385 PHONE 860-437-4504 FAX 860-437-4505

1.Complete a form for each child. Pre-registration is required.

2.Check the desired camps in the bottom section of the form.

3.A non-refundable deposit of $25 per week of camp, is required at the time of registration.

4.Multiple camp discounts available, as indicated below, for more than 4 weeks of camp.

5.Payment for each camp is due in full the Friday prior to the camp.

6.Early drop off or late pick up is available for $30 per week [7:30 a.m. to 5:30 p.m.] and must be indicated at registration.

Participant's Name: _____________________________________ Age:_______ DOB:_______ Gender:______

Address:____________________________________________________________________ Zip:______________

Home Phone: ____________ Work Phone:____________________ Cell Phone_______________

Mother's Name:_________________________________ Father's Name:_________________________________

Family Doctor:__________________________________ Doctor's Phone:________________________________

In case of emergency, contact:___________________________________________________________________

Relationship:_________________ Phone:________________________________________

List any known allergies (Include bee stings, food and drug allergies):_________________________________________________________

List all medications the participant uses on a regular basis:_________________________________________________________________

Does the participant have any physical conditions which limit his/her participation in any activites? Yes No

If yes, please explain:_________________________________________________________________________________________

May your child participate in swimming and/or water activities? Yes No

Waiver: I hereby waive and release any and all rights for myself , my heirs, executors, and administrators this enrollee may have against

Kidsports or its representatives, agents, and successors for any and all injuries the participant may suffer in connection with his/her participation in any Kidsports Summer Camp program.

Signed:______________________________________________________________ Date:________________________________________

Medical Waiver: We understand that in case of emergency and we are unable to be contacted, we give permission to Kidsports to

authorize any emergency action necessary to insure the safety of our child. Which hospital do you wish to use, if needed?

Hospital:__________________________________________

This does not in any way hold Kidsports financially responsible or otherwise liable for any medical or emergency care given. I permit my child to participate in all activities at Kisports and to be transported to off-site field trips.

Signed:________________________________________________________________ Date:______________

2009 Summer Camp Rates	All Day Camps Mon-Fri 9am-5pm Ages 5-14	Weesports Camps Mon-Fri 9am-5pm Ages 3-5 (must be toilet trained)	Specialty Camps	Meal Deals
1-4 weeks 5-10 weeks	$150 per week $130 per week	9am-Noon 9am-5pm $90 per week $150 per week $80 per week $130 per week	TBA	$5 per day or $20 per week

Dates

KS Camp

Camp

Theme/Specialty Camp

Early/

Late

$30

Total

Cost

Deposit

Method

Date

Staff

INT

Bal

Due

Bal

Paid

Date

Method

Staff INT

6/22-

6/26

Unbirthday Day. Imagine 364 days of your birthday celebration!

6/29-7/3

Pirate Week

7/6- 7/10

Rockstar Week

7/13-7/17

Super Hero Week

UK Soccer -Specialty Camp

7/20-7/24

Wet and Wild Week- Water Water and more Water!

Baseball- Specialty Camp

7/27-7/31

Animal Planet Week

UK Soccer- Specialty Camp

8/3-8/7

Camp Olympics

8/10-8/14

Hawaiian Week

8/17-8/21

Golf-Specialty Camp

8/24-8/28

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