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2015 Summer Camp Enrollment NON-MEMBER
NM
Half Day AM 9:00 am - 12:00 pm Full Day 9:00 am - 3:30 pm
Half Day PM 12:30 pm - 3:30 pm Extended Care is also available.
Gymnastics
(215)328-0900
Please Circle
Dates
Theme
1) AM PM or FULL
June 22-26
Glitz & Glamour
2) AM PM or FULL
June 29-Jul 3
Magical Madness
3) AM PM or FULL
July 6-10
Cute Chefs
4) AM PM or FULL
July 13-17
Zumbalicious
(______)_______________________ 5) AM PM or FULL
Cell or Work Phone (please circle)
July 20-24
Magnificent
Masterpieces
6) AM PM or FULL
July 27-31
Zoo-a-rama
7) AM PM or FULL
Aug 3-7
Magazine Models
8) AM PM or FULL
Aug 10-14
Carnival Craze
9) AM PM or FULL
Aug 17-21
Music Makers
362 S. Warminster Rd. Hatboro, PA. 19040
Student & Family Information
________________________ ______________________
First Name
Last Name
___/___/___
Date of Birth
Email address __________________________________________
(for billing and important camp correspondences)
(______)_____________________
Home Phone
_____________________________
Street Address
___________________ ______ ____________
City
State
Zip code
Guardian Information
_____________________
Mother’s Name
(_____)______________
Alternate Number
_____________________
Fathers’s Name
(_____)______________
Alternate Number
Prior gymnastics experience ____________________________
T-Shirt Size
_____________________________________________________
6-8
CL
10-12 14-16
AS
AM
How did you hear about us? _______________________
Emergency Contact:
____________________________________________________
Disabilities or conditions requiring our special attention?
CS CM
In the event of an accident who to call if parents are unavailable
____________________________
___________________
Name
_____________________________________________________
Relation to student
(______)________________
Phone Number
Method of Payment: ____Enclosed is a check payable to ‘Ricochets Gymnastics’
Charge to: ___Visa*___MasterCard* (*card provided will be electronically stored on your account. All cards are subject to 2% convenience fee)
__ __ __ __ - __ __ __ __ -__ __ __ __ - __ __ __ __
__ __ __
__ __ / __ __
Card Number
CVV2 Code*
Expiration Date
__________ AMOUNT TO BE CHARGED (minimum charge must cover deposit- $50 per wk per child)
___________________________________
Name of Cardholder
_______________________________
Signature of Cardholder
FOR OFFICE USE ONLY:
As the parent(s) or legal guardian(s) of the student(s) named above, I hereby consent to his/her participation in the programs offered by Ricochets Gymnastics,
Inc. and to the use of all facilities at Ricochets Gymnastics, Inc. As a condition to participation in RICOCHETS programs, I hereby release and forever discharge
Sarah Lang and Christopher Zimmerman and/or any employees,or any individual acting on behalf of RICOCHETS, and connected with this program in which I, or
my child may participate, from any and all claims, demands,or losses of every kind and nature which may result to my child, myself, or my heirs, except where
such losses or damages is the result of the intentional or reckless conduct of one of the organizations or individuals identified above. I recognize and acknowledge
all risks involved in participation in the above program and assume all risks inherent in participation in the same. I am aware that individual and group publicity
photos and videos are taken from time to time, and I hereby grant permission for my or my child(ren)'s likeness to be used in Ricochets Gymnastics publicity or
advertising. I have read and fully understand this liability waiver, and agree to the club policies.
Parent signature ___________________________________________________ Date__________________
NM