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$99
CSA is offering many options to the
Best Fun Summer Camp
4 Day Summer Camp Sessions
1 Day Summer Camp
1/2 Day Summer Camp
Additional Early Drop Off & Late Pick up Times
No Annual Family Registration Fee required to join Summer Camp
Gymnastics
Swim
Fit N'astics
Tumbling & Trampoline
Arts & Crafts
Music Activities
Soccer - Volleyball - Basketball
Sport Games Pit Activities
Surprise Themes & Activities
Cheer - Pom Board Games
Social Time Reading Time
Participation in activities is always voluntary
Call for more information 608-756-0444
Summer Camp
for
Boys & Girls
6 yr-12yrs
Register to a 4 Full Day
CSA Fun Summer Camp
Session
June15th-18th
or
June 22th-25th
To receive
FREE
CSA Kids
Sports Arts Campus
Building healthy bodies & educated since 1974
4113 Whitney St.
Janesville WI
608-756-0444
www.csakids.com
the month of July classes for
a sibling 18 month—5 yrs old
For the
Gym N'Cricket Gymnastics Program
Offer good till June 22th 2015
One offer per Family Not valid with any other offer
Active Students in Gym N’ Cricket not included in this offer
No annual registration fee for July for sibling
Today’s Date___/___/___
CSA Kids Fitness Fun & Learning Summer Camp
June 15 thru August 27 2015 Registration Form
Name _________________________________Sex F /M Age____ D.O.B._____/_____/_____ Home Phone
(
Participant
)_______ - _________
Address________________________________________________________City_________ State_______ Zip__________
E-Mail___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/___/__Cell Phone (
Parent Name __________________________________________Work Phone (
)_____-__________
)________-_________
Phone # where Parent can be reached during Camp days at CSA Kids
(
) _______ - _________
Circle the weeks your child will be attending Monday –Thursday Time: 9:00-4:00 $99
June 15-18 June 22-25 June 29-July 2 July 6-9 July 13-16 July 27-29 Aug.3-6 Aug.10-13 Aug.17-20 Aug.24-27
Circle the 1/2 day weeks your child will be attending Circle Time 9:00-1:00 or 12:00-4:00
June 15-18 June 22-25 June 29-July 2 July 6-9 July 13-16 July 27-29 Aug.3-6 Aug.10-13 Aug.17-20 Aug.24-27
One full day $28 Day_____ Date____/___/_____Time_______
No Registration Fee if only registering to Summer Camp 6/15-8/27 2015
Tuition
Full payment # wks (
)
$____________
Tuition 1/2 payment # wks (
)
$____________
Tuition (1 full day)
$____________
Tuition (1/2 day)
$____________
Additional time: $4.00 per hour per day 7:00-9:00am or 4:00-5:30pm
Week of____-______ total Hrs____
$___________
TOTAL ENCLOSED
$_____________
Date Paid______/______/______ Cash______
Check #___________
Visa/MC/Disc.__________/_________/________/_______Exp___/___
Signature___________________________________________________
Fax Registration form with
Credit card info to
608-756-5474
15campSinh&web
Mail Registration form &
make
Check payable to CSA Kids
4113 Whitney Street
Janesville WI 53546
1/2 day $19 Day_____ Date____/___/_____Time_______
CSA will Auto Draw every Wednesday that you child is registered to a 4 day camp if
payment is not made on the Monday of the camp week. Please read and sign
Auto-Withdrawal Authorization
I _____________________________________________________ , the holder of a
valid MC, VS or DS credit or debit Card hereby authorize Creative School of Arts, Inc.
d/b/a CSA kids Sports & Arts Campus, to charge my credit or debit card for enrollment
in classes held by CSA Kids. I also understand that I am liable for the full tuition whether
my child attends the classes registered for. I agree to notify CSA Kids immediately of any
change in the status of my credit, debit card including but not limited to card expiration,
name change, limitation of use, loss or theft of the card, etc. In the event that the amount
charged is refused for whatever reason, I accept responsibility for full payment for the
amount charged as well as any late charges incurred. I further recognize that nonpayment for services may result in the suspension of my family’s enrollment in classes.
4 day Summer Camp Tuition $99
Visa/MC/Disc.__________/_________/________/_____________Exp___/___
Signature___________________________________________________
_
________________________________________________________________
Print Name
Assumption of Risk, Waiver of Liability, Promise to Pay, Medical Authorization
I/We recognize that potentially severe injuries, including permanent paralysis or death can occur in sports or activities involving height or motion including but not limited to
gymnastics, tumbling, trampoline, martial arts, dance, cheerleading swimming, music, preschool and exercise activities. In addition, swimming or any activity in or around
water can result in brain damage or drowning. Being fully aware of these dangers, I voluntarily consent to myself or minor child participating in any and all CSA Kids programs, camps and activities and I ACCEPT ALL RISKS associated with that participation.
In consideration for allowing myself or minor child to use these facilities, I, on my own behalf and the behalf of my child and our respective heirs, administrators, executors
and successors, hereby COVENANT NOT TO SUE and FOREVER RELEASE CSA Kids, its officers, directors, shareholders, employees or agents from all liability for any
and all damages or injuries suffered by me or my minor child while under the instruction, supervision, or control of CSA Kids including, without limitations, those damages or
injuries resulting from act of negligence on the part of its officers, directors, shareholders, employees or agents.
In the event of an accident or emergency I would like myself above or minor child to be taken to a hospital for medical treatment and I hold CSA Kids, and its representatives
harmless in this execution of this action. Additionally, I hereby agree to individually provide for all possible future medical expenses which may be incurred by myself or my
minor child as a result of any injury sustained while participating at or for CSA Kids.
I have read and understand this ASSUMPTION OF RISK and WAIVER OF LIABILITY, PROMISE TO PAY and MEDICAL AUTHORIZATION and I VOLUNTARILY affix my
Medical Marketing Release
For the Medical Release I undersigned gives permission for the CSA Kids officers, employees, and/or agents to seek emergency medical treatment for the
participants (s) in the event they are unable to reach any parent or guardian . The undersigned also agrees that they themselves will be responsible for any
financial debt incurred by said action. For the Marketing Release I understand tat my child’s likeness may be used in CSA kids ads, promotional videos, our
website or various other marketing materials. These images wilbe used for CSA Kids purposes only and will not be given or sold to outside companies or
individuals.
__________________________________________________________________________________/____________________________________________________
Signature
Parent or legal Guardian
Print Name
Date