Download - HIAC Camp Registration Form2

8/11/2019 HIAC Camp Registration Form2

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PAYMENT

Does Yor Child Have Dail Charging Privileges? qYes qNo qCash_____

Transacion Tpe: qCash qClb Charge ( Member #________________ ) qCheck ( #_________ )

qCredi Card *Non-Members ms have CC#on ile or pre-pa or each camp

Credi Card Tpe: qVisa qAMEX qDiscover qMC

Name on Card ________________________________________________ Credi Card #_______________________________________________

Expiraion _____________________ Toal Paid _____________________Dae Paid ____________________ Billing Zip Code _________________

Ahorizing Signare __________________________________________________________________________Sa Iniials _________________

Todas Dae _______________________

hilds Name _______________________________________________________________________________________ DOB _____ / _____ / __

Parens Name(s) _____________________________________________________ Child is a qMember # ________________ orqNon-Mem

Address ___________________________________________________________________________ Ci _____________________Zip _________

Home Nmber (_______) _______________________________Conac Nmber Dring Camp (_______) _______________________________

-Mail Address _____________________________________________________ Childs School ________________________________________

SELECT A SCHEDULE Harbor Island oers lexibili in is childrens programming.Pre-regiser and prepa p o week in advance and ge 10% discon on he below packages.

Exended Care Hors: qEarl Care, 7:30AM-8:30AM qAer Care, 4PM-6PMCamp Hors: 8:30AM-4PM

2013 BLAST! CAMPREISTRATION FORM

2 Da Packq$90/Member q$100/Non-Member*




n special needs/medicaion we shold know abo? ______________________________________________________________________

____________________________________________________________________________________________________ Iniial _________

HAT TO BRIN: qAhleic Clohing & Shoes qBahing Si qSnscreen qNon-skid, closed oe shoes qDrinks qLnch & Snacks

mpers ms bring a bagged lnch each da. I a camper does no have a bagged lnch, ha paren will be conaced. Parens shold also pack sna

d drinks or children. *Please inorm consolors i or child has peans or pean ber prodcs.

ease do no o bring:Cell Phones, Video ames, I-pods/ MP3 Plaers, Towels, Tos

AIVER:I hereb, or msel, agens and adminisraors, waive and release an and all righs and claims or damages I ma have agains Harbor I

hleic Clb and Spa, heir sponsors respecive agens, represenaives, sccessors and assignees, or an and all injries which ma occr in conne

h he paricipaion o m minor child in his camp program, I have read and ndersand he above.

horizing Signare ________________________________________________________________________________________________________

Week

1: Ma 28-31 qW qTH qF q3 Das$_____

2:Jne 3-7 qM qT qW qTH qF q5 Das$_____

3: Jne 10-14 qM qT qW qTH qF q5 Das$_____



6: Jl 1-3, 5 qM qT qW qF q4 Das$_____

7: Jl 8-12 qM qT qW qTH qF q5 Das$__



10: Jl 29-Ags 2 qM qT qW qTH qF q5 Das$__

11:Ags 5-9 qM qT qW qTH qF q5 Das$__

12:Ags 12-16 qM qT qW qTH qF q5 Das$__

13:Ags 19 qM q1 Da $__

q$50/Member/Da q$55/Member/Da

Add Exended Care: q$7/Member q$10/Non-Member


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HEALTH WARRANTY __________

Paricipan warrans and represens ha he/she has no disabili, impairmen or ailmen prevening him/her rom engaging

in acive or passive exercise ha will be derimenal o his/her healh, sae or phsical condiion i he/she does so engage

or paricipae. This represenaion is made b Paricipan knowing ha managemen will rel pon same respec o heregisraion o Paricipan.

PHOTO RELEASE __________

The ndersigned hereb agrees o he phoographic or elecronic reprodcion and se o heir image and/or likeness or hose

o he minor Child/Paricipan indicaed herein aken while paricipaing in he program in markeing and adverising vehicles

now and in he ininie re or he Clb. The ndersigned acknowledges and ndersands ha here will be no compensaion

or oher ees or hese ses.

RULES & REULATIONS __________

Paricipan herender is bond b and shall compl wih he rles and reglaions, policies and procedres o he Clb.

LIABILITY AND WAIVER OF LIABILITY __________

Paricipan acceps ll responsibili or his/her se o an and all apparas, acili, privilege or service whasoever, owned

and operaed b his Clb or an acivi organized or sponsored b he Clb eiher on or o he Clbs premises a his or her

own risk and shall hold his Clb and is shareholders, direcors, oicers, emploees, represenaives and agens harmless rom

an and all loss, claim, injr, damage or liabili ssained or incrred b him/her resling hererom.

TAX ISSUES __________

Yo ms save all receips and program regisraion orms i o will be dedcing he cos o Smmer Camp on or axes.

Wellbridge Clb managemen DBA, Ahleic Clb Norheas is no responsible or creaing or mainaining ha inormaion.

REFUND POLICY __________

Rends will be given or cancellaions made prior o he sar o seasonal camps, mins a $60 srcharge. Cancellaions made

aer he sar o seasonal camps, inclding b no limied o, prepaid or preseleced weeks are non-rendable.

HEALTH INFORMATION __________

All healh ino ms be received beore or childs irs da o aendance, or he will no be permied o aend camp.

ILLNESS POLICY __________

Rends/ransers will no be issed i a child misses an das o camp de o common illness sch as he l, colds, chicken

pox, srep hroa, ec. I a child canno aend de o a docmened phsical condiion (a broken bone) a rend ma be issed ahe direcors discreion a no more han a 50% rend.

813.202.1950 | 900 S. Harbor Island Blvd. | HarborIslandAhleicClb.com

SUMMER CAMP POLICIESB signing his agreemen (signare on reverse), I hereb accep and acknowledge he ollowing erms & condiions