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2015 summer camp enrollment
360 Tumble and Gymnastics 755 Ash Street ∙ Canton, GA 30114 ∙ 770.704.1750 ∙ www.360tumble.com ∙ [email protected] Part a: participant and policy information
Parent Name: __________________________________________________ 2nd Parent Name: _________________________________
Address: ______________________________________________________ City: _____________
Zip: ___________________
Home Phone: __________________________________________________ Cell Phone: ______________________________________
Email Address: _________________________________________________ 2nd Parent Phone: _________________________________
Emergency Contact: __________________________ Relationship: ____________________
Phone: __________________
Participant Name: ____________________________ Age: _____
Gender: [ ] F [ ] M
DOB: ________
Please list any food allergies or medical conditions/challenges your child’s coach should be aware of for safety and instructional purposes:
_____________________________________________________________________________________________________________
Is camp participant currently a registered member of 360? [ ] Y [ ] N Registration Date: __________________________________
(All camp participants must be registered members of 360 Tumble and Gymnastics and have paid the annual registration fee.)
Please list all adults other than parents who have permission to pick your child(ren) up from the gym.
Name
Phone 1
Phone 2
Relationship
Part b: camp pricing
Weekly (Full)
Weekly (Half)
Daily (Full)
Daily (Half)
Entire Summer (Full)
Entire Summer (Half)
Extended Care
Unlimited Ext Care
Price
$199
$130
$50
$30
$1254
$890
$5/hr
$150
Savings**
20%
17%
30%
24%
-
Deposit
50%
50%
50%
50%
25%
25%
50%
Balance Due Date
Camp Start
Camp Start
Camp Start
Camp Start
Camp Start
Camp Start
Camp Start
Camp Start
Sibling Discount*
10%
10%
10%
10%
10%
10%
-
Multi-Camp Discount
10%
10%
10%
10%
-
*Sibling and Multi-Camp discounts cannot be combined for a 20% discount. **Savings based on daily rates.
Part c: camp policies and procedures
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A deposit is required to secure your child’s camp spot and is non-refundable within 10 days of camp start
You should pack a sack lunch for campers as well as a snack for full day campers
Appropriate gym clothes should be worn and hair should be pulled up. No jewelry, no buckles, no zippers.
The camp balance is due on the first day of camp.
If you sign up for extended care, you are required to pay for the hours listed.
Please sign below to indicate that you have read, understand and agree to camp information and pricing.
Signature: _______________________________________________________________________
Date: _________________
2015 summer camp enrollment
360 Tumble and Gymnastics 755 Ash Street ∙ Canton, GA 30114 ∙ 770.704.1750 ∙ www.360tumble.com ∙ [email protected] Part D: camp enrollment information Participant Name ________________________________
Gym Level: BEG
Camp Dates
Camp Theme
June 1-5
It’s Summer Time
Half Day
Full Day
June 8-12
Dr. Seuss Fun
Half Day
Full Day
June 15-19
Carnival Craze
Half Day
Full Day
June 22-26
Olympics
Half Day
Full Day
Half Day
Full Day
June 29-July 3 Red, White & Blue
July 6-10
Movie Mania
Half Day
Full Day
July 13-17
Pirates & Princesses
Half Day
Full Day
July 20-24
Everyday Heroes
Half Day
Full Day
July 27-31
Back to School
Half Day
Full Day
Weekly
INTER
ADV
Daily (Circle Days)
Half Day
M T
Half Day
M T
Half Day
M T
Half Day
M T
Half Day
M T
Half Day
M T
Half Day
M T
Half Day
M T
Half Day
M T
W
W
W
W
W
W
W
W
W
Full Day
Th F
Full Day
Th F
Full Day
Th F
Full Day
Th F
Full Day
Th F
Full Day
Th F
Full Day
Th F
Full Day
Th F
Full Day
Th F
Ext Care
7-9a & 4-6p
Hrs:___
Hrs:___
Hrs:___
Hrs:___
Hrs:___
Hrs:___
Hrs:___
Hrs:___
Hrs:___
2015 summer camp enrollment
360 Tumble and Gymnastics 755 Ash Street ∙ Canton, GA 30114 ∙ 770.704.1750 ∙ www.360tumble.com ∙ [email protected] Part D: camp enrollment information Participant Name ________________________________
Gym Level: BEG
Camp Dates
Camp Theme
June 1-5
It’s Summer Time
Half Day
Full Day
June 8-12
Dr. Seuss Fun
Half Day
Full Day
June 15-19
Carnival Craze
Half Day
Full Day
June 22-26
Olympics
Half Day
Full Day
Half Day
Full Day
June 29-July 3 Red, White & Blue
Weekly
July 6-10
Movie Mania
Half Day
Full Day
July 13-17
Pirates & Princesses
Half Day
Full Day
July 20-24
Everyday Heroes
Half Day
Full Day
July 27-31
Back to School
Half Day
Full Day
INTER
ADV
Daily (Circle Days)
Half Day
M T
Half Day
M T
Half Day
M T
Half Day
M T
Half Day
M T
Half Day
M T
Half Day
M T
Half Day
M T
Half Day
M T
W
W
W
W
W
W
W
W
W
Full Day
Th F
Full Day
Th F
Full Day
Th F
Full Day
Th F
Full Day
Th F
Full Day
Th F
Full Day
Th F
Full Day
Th F
Full Day
Th F
Ext Care
8-9a & 4-6p
Hrs:___
Hrs:___
Hrs:___
Hrs:___
Hrs:___
Hrs:___
Hrs:___
Hrs:___
Hrs:___
2015 summer camp enrollment
360 Tumble and Gymnastics 755 Ash Street ∙ Canton, GA 30114 ∙ 770.704.1750 ∙ www.360tumble.com ∙ [email protected] Week 1
Camp Subtotal $__________ + EXC $_________
Discount $_______ Sibling (10%) Multi (10%)
Camp Total $______________________________
Week 2
Camp Subtotal $__________ + EXC $_________
Discount $_______ Sibling (10%) Multi (10%)
Camp Total $______________________________
Week 3
Camp Subtotal $__________ + EXC $_________
Discount $_______ Sibling (10%) Multi (10%)
Camp Total $______________________________
Week 4
Camp Subtotal $__________ + EXC $_________
Discount $_______ Sibling (10%) Multi (10%)
Camp Total $______________________________
Week 5
Camp Subtotal $__________ + EXC $_________
Discount $_______ Sibling (10%) Multi (10%)
Camp Total $______________________________
Method:
Date:
Staff:
Deposit
_______
_______
_______
Deposit
_______
_______
_______
Deposit
_______
_______
_______
Deposit
_______
_______
_______
Deposit
_______
_______
_______
Balance
_______
_______
_______
Balance
_______
_______
_______
Balance
_______
_______
_______
Balance
_______
_______
_______
Balance
_______
_______
_______
Week 6
Camp Subtotal $__________ + EXC $_________
Discount $_______ Sibling (10%) Multi (10%)
Camp Total $______________________________
Method:
Date:
Staff:
Deposit
_______
_______
_______
Balance
_______
_______
_______
Week 7
Camp Subtotal $__________ + EXC $_________
Discount $_______ Sibling (10%) Multi (10%)
Camp Total $______________________________
Method:
Date:
Staff:
Deposit
_______
_______
_______
Balance
_______
_______
_______
Week 8
Camp Subtotal $__________ + EXC $_________
Discount $_______ Sibling (10%) Multi (10%)
Camp Total $______________________________
Method:
Date:
Staff:
Camp Subtotal $__________ + EXC $_________
Discount $_______ Sibling (10%) Multi (10%)
Camp Total $______________________________
Method:
Date:
Staff:
Deposit
_______
_______
_______
Deposit
_______
_______
_______
Balance
_______
_______
_______
Balance
_______
_______
_______
Participant Name ________________________________ Week 9
Part E: participant and policy information Method:
Date:
Staff:
Method:
Date:
Staff:
Method:
Date:
Staff:
Method:
Date:
Staff:
2015 summer camp enrollment
360 Tumble and Gymnastics 755 Ash Street ∙ Canton, GA 30114 ∙ 770.704.1750 ∙ www.360tumble.com ∙ [email protected] Part F: special event info and release form Please initial that you have read and understand each listing below. By initialing each item you are agreeing to the
terms of the Release of Liability and to allow your child named above to participate in the special event. Please read
each item carefully.
______ Lunch & Snacks with no nuts – I understand that my child(ren) must bring a lunch and a snack for half
day camp, and a lunch and two snacks for a full day of camp. We are nut allergy sensitive and ask that you do not pack
your child any nut related products.
_______ 360 Water Day - Each Thursday we will hold a water day. All activities will be held either in the grassy
area next to the 360 Tumble and Gymnastics facility or behind the building. On water day, campers should wear their
swimsuit to camp under shorts and a t-shirt. One piece bathing suits are preferred but not required. Water day
participants will have fun playing with an inflatable water slide, bubble, water bubbles, sprinklers, and other water day
events. Don’t forget to apple sunscreen beforehand! If you do not want your child participating in any of those activities
please tell a 360 Tumble and Gymnastics member.
______ The Bounce House – Wednesday/Friday – 360 campers will jump with joy when we visit the Bounce
House! The Bounce House is an inflatable amusement and play center located across the 360 parking lot. All campers
will need to bring socks. If you forget to bring socks 360 will provide socks for $1. Since campers will be walking to the
Bounce House please remember to provide shoes for your child. For more information on The Bounce House please
visit them online at: www.thebouncehouseac.com.
The Bounce House Amusement Center
In consideration of being allowed to enter the play area and participate in the 360 Tumble and Gymnastics camp field
trip at Bounce House Amusement Center (BHAC), the undersigned, on his or her behalf, and/or behalf of the participant
noted above, acknowledges, appreciates, and agrees to the following conditions. I, the parent/legal guardian of the
participant agree that the participant and I shall comply with the stated and customary terms, rules and conditions for
the participation in any party or function at BHAC. I am aware that participation in BHAC field trip and/or use of the
facility play area and inflatable equipment creates a risk of injury, and I, on behalf of myself and the participant’s
knowingly and freely assumes all risks, both known and unknown, even if arising from the negligence of others. I, for
myself and the participant, and our respective heirs, assigns, administrators, personal representatives, and next of kin,
hereby release and hold harmless BHAC LLC, their affiliates, officers, members, agents, employees, other participants,
and sponsoring agents from and against any and all claims, injuries, liabilities, or damages arising out of or related to
participation in and all Bounce House functions and the use of the play area and/or inflatable equipment.
_______ Pizza Lunch – Friday - 360 will provide either a cheese or pepperoni pizza lunch for all campers. If your
child does NOT like pizza please provide a sack lunch for them on Friday as well. Don’t forget to pack a one snack for
a half day camper or two snacks for a full day camper
.
______ Sunscreen - We ask that if your child(ren) need(s) sunscreen you apply it prior to drop off.
______ Photo Release - I am aware that individual and group photos and videos are taken during summer camp
activities and events. I hereby grant my child’s likeness to be used in 360 Tumble and Gymnastics publicity, marketing,
advertising, and website.
Please sign below that you understand the information provided above and that you agree to the terms in the Release
Signature: _____________________________________________________________________ Date: ________