Youth Summer Camp Enrollment Form and Release of Liability for

Youth Summer Camp Enrollment Form and Release of
Liability for NON-MEMBERS for Summer of 2015
Please put an “x” in the box and circle the camp(s)
you are registering for
Week 1: June 8 – 12
 Camp Animal Lovers, Ages 6-12 ($56) Tuesday, June 9
 Just For Me Camp, Ages 2 ½ - 7 ($15) Tuesday, June 9
 Girls Forum Camp, Ages 8-12 ($67) Thursday, June 11 & Friday, June 12
 RAC Cheer Camp, Ages 3-4 ($85) Monday, June 8 – Friday, June 12
 RAC Cheer Camp, Ages 5-6 ($90) Monday, June 8 – Friday, June 12
 RAC Cheer Camp, Ages 7-12 ($115) Monday, June 8 – Friday, June 12
 Rochester Honkers Baseball Camp, Ages 6-13 ($113) Thursday, July 11 –
Saturday, July 13
 RAC Rowing Camp, Ages 12 – 17 and up ($130) Monday, June 8 – Friday, June
12
 RAC Week Camp – Full day, Ages 5-13 ($220) Monday, June 8 – Friday, June 12
___ Early drop off ($10/day)
___ Late pick up ($4/day)
 RAC Week Camp – AM half day, Ages 5-13 ($140) Monday, June 8 – Friday,
June 12 ___ Early drop off ($10/day) ___ Late pick up ($4/day)
 RAC Week Camp – PM half day, Ages 5-13 ($140) Monday, June 8 – Friday,
June 12 ___ Early drop off ($10/day)
___ Late pick up ($4/day)
Week 2: June 15 – June 19
 Camp Animal Lovers, Ages 6-12 ($56) Thursday, June 18
 Just For Me Camp, Ages 2 ½ - 7 ($15) Tuesday, June 16
 RAC Week Camp – Full day, Ages 5-13 ($220) Monday, June 15 – Friday, June
19
___ Early drop off ($10/day)
___ Late pick up ($4/day)
 RAC Week Camp – AM half day, Ages 5-13 ($140) Monday, June 15 – Friday,
June 19 ___ Early drop off ($10/day) ___ Late pick up ($4/day)
 RAC Week Camp – PM half day, Ages 5-13 ($140) Monday, June 15 – Friday,
June 19 ___ Early drop off ($10/day)
___ Late pick up ($4/day)
Week 3: June 22 – June 26
 Cascade Meadow Explorers, Ages 6-12 ($67) Thursday, June 25 & Friday,
June 26
 Just For Me Camp, Ages 2 ½ - 7 ($15) Tuesday, June 23
 Kids in Action Camp, Ages 4-5 ($64) Monday, June 22 – Thursday, June 25
 Kids in Action Camp, Ages 6-7 ($64) Monday, June 22 – Thursday, June 25
 Kids in Action Camp, Ages 8-9 ($64) Monday, June 22 – Thursday, June 25
 Iddy Biddy Soccer, Ages 3-4 ($85) Monday, June 22 – Friday, June 26
 Tiny Soccer, Ages 5-6 ($90) Monday, June 22 – Friday, June 26
 Youth Soccer, Ages 7-9 ($115) Monday, June 22 – Friday, June 26
 Junior Soccer, Ages 10-12 ($120) Monday, June 22 – Friday, June 26
Week 4: July 6– July 10
 Just For Me Camp, Ages 2 ½ - 7 ($15) Tuesday, July 7
 Kids in Action Camp, Ages 4-5 ($64) Monday, July 6 – Thursday, July 9
 Kids in Action Camp, Ages 6-7 ($64) Monday, July 6 – Thursday, July 9
 Kids in Action Camp, Ages 8-9 ($64) Monday, July 6 – Thursday, July 9
Week 5: July 13 – July 17
 Just For Me Camp, Ages 2 ½ - 7 ($15) Tuesday, July 14
 RAC Rowing Camp, Ages 18 and up ($135) Monday, July 13 – Friday, July 17
 RAC Tiny Basketball Camp, Ages 5-6 ($90) Monday, July 13 – Friday, July 17
 RAC Youth Basketball Camp, Ages 7-9 ($115) Monday, July 13 – Friday, July 17
 RAC Junior Basketball Camp, Ages 10-12 ($120) Monday, July 13 – Friday,
July 17
Week 6: July 20 – July 24
 Just For Me Camp, Ages 2 ½ - 7 ($15) Tuesday, July 21
Week 7: July 27 – July 31
 RAC Cheer Camp, Ages 3-4 ($85) Monday, July 27 – Friday, July31
 RAC Cheer Camp, Ages 5-6 ($90) Monday, July 27 – Friday, July 31
 RAC Cheer Camp, Ages 7-12 ($115) Monday, July 27 – Friday, July 31
 Camp Animal Lovers, Ages 6-12 ($56) Tuesday, July 28
 Cascade Meadow Explorers, Ages 6-12 ($67) Thursday, July 30 &
Friday, July 31
 Just For Me Camp, Ages 2 ½ - 7 ($15) Tuesday, July 28
Week 8: August 3 – August 7
 Camp Animal Lovers, Ages 6-12 ($56) Thursday, August 6
 Just For Me Camp, Ages 2 ½ - 7 ($15) Tuesday, August 4
Week 9: August 10 – August 14
 Kids in Action Camp, Ages 4-5 ($64) Monday, August 10 – Thursday, August 13
 Kids in Action Camp, Ages 6-7 ($64) Monday, August 10 – Thursday, August 13
 Kids in Action Camp, Ages 8-9 ($64) Monday, August 10 – Thursday, August 13
 Just For Me Camp, Ages 2 ½ - 7 ($15) Tuesday, August 11
 RAC Week Camp – Full day, Ages 5-13 ($220) Monday, August 10 – Friday,
August 14 ___ Early drop off ($10/day)
___ Late pick up ($4/day)
 RAC Week Camp – AM half day, Ages 5-13 ($140) Monday, August 10– Friday,
August 14 ___ Early drop off ($10/day)
___ Late pick up ($4/day)
 RAC Week Camp – PM half day, Ages 5-13 ($140) Monday, August 10– Friday,
August 14 ___ Early drop off ($10/day)
___ Late pick up ($4/day)
Week 10: August 17 – August 21
 Just For Me Camp, Ages 2 ½ - 7 ($15) Tuesday, August 18
 RAC Week Camp – Full day, Ages 5-13 ($220) Monday, August 17 – Friday,
August 21 ___ Early drop off ($10/day) ___ Late pick up ($4/day)
 RAC Week Camp – AM half day, Ages 5-13 ($140) Monday, August 17 – Friday,
August 21 ___ Early drop off ($10/day) ___ Late pick up ($4/day)
 RAC Week Camp – PM half day, Ages 5-13 ($140) Monday, August 17 – Friday,
August 21 ___ Early drop off ($10/day) ___ Late pick up ($4/day)
Week 11: August 24 – August 28
 Just For Me Camp, Ages 2 ½ - 7 ($15) Tuesday, August 25
 RAC Week Camp – Full day, Ages 5-13 ($220) Monday, August 24 – Friday,
August 28 ___ Early drop off ($10/day) ___ Late pick up ($4/day)
 RAC Week Camp – AM half day, Ages 5-13 ($140) Monday, August 24 – Friday,
August 28 ___ Early drop off ($10/day) ___ Late pick up ($4/day)
 RAC Week Camp – PM half day, Ages 5-13 ($140) Monday, August 24 – Friday,
August 28 ___ Early drop off ($10/day) ___ Late pick up ($4/day)
Week 12: August 31 – September 4
 RAC Week Camp – Full day, Ages 5-13 ($220) Monday, August 31 – Friday,
September 4 ___ Early drop off ($10/day)
___ Late pick up
($4/day)
 RAC Week Camp – AM half day, Ages 5-13 ($140) Monday, August 31– Friday,
September 4 ___ Early drop off ($10/day)
___ Late pick up
($4/day)
 RAC Week Camp – PM half day, Ages 5-13 ($140) Monday, August 31– Friday,
September 4 ___ Early drop off ($10/day)
___ Late pick up
($4/day)
1. Fill out the second page of this form completely.
2. Payment and this form must be received in order for child to be enrolled in camp.
3. “Summer Camp Important Information Form” must be filled out in order for child to participate in
camp.
4. Please read “Things to Bring and Know” list before bringing child to camp.
Youth Summer Camp Enrollment Form and Release of
Liability for NON-MEMBERS for Summer of 2015
Non-Member information (For RAC Use: Please search for Non-member as a previous guest before entering as a new guest).
* One child per application.
__________________________
Child’s Name (printed)
/ ________ /
Date of Birth
___
______________________________________
Child’s Home Phone Number
______________________________________________________________________________________
Parent’s Name (printed)
______________________________________
Parent’s Contact Phone Number
_______________________________________________________________________________________
Emergency Contact Name (other than Parent, if possible)
______________________________________
Emergency Contact Phone Number
_________________________________________________________________________________________________________________________________________
Parent/Child Street Address
City
State
Zip
In order to register for a Camp, this form must be filled out completely (and include a check made out to RAC or Credit Card Information) and mailed, scanned/emailed to
[email protected], or dropped off at the RAC Activities Desk. Our mailing address is 3100 19th Street NW, Rochester, MN 55901 C/O Anna Stroud. If you are mailing
in the application, please include a check, do not send cash. If paying by Credit Card please fill out the following:
 Visa
 Master Card
 Discover
___________________________________
Credit Card Number
 American Express
______________________________________________________
Signature of Cardholder
_________________
3 Digit Security Code
4 Digit – Amer. Express
___________________________
Expiration Date (Month and Year)
________________________________________________________
Print Cardholder’s Name
Release of Liability
I acknowledge that use of the services, activities and facilities of the Rochester Athletic Club carries a risk of serious personal injury or death. As consideration for my being
permitted to use the facilities and services and participate in the activities of Rochester Athletic Club, I EXPRESSLY AGREE TO ASSUME ALL RISK OF SERIOUS INJURY OF DEATH, and
TO RELEASE ROCHESTER ATHLETIC CLUB, it offices, directors, employees, agents, successors, and assigns (“the Related Parties”) from liability for injuries, damages or other loss
caused by THE NEGLIGENCE OR STRICT LIABILITY of the Released Parties. I do not release them from liability for willful or intentional conduct or punitive damages. I also understand
that this Release applies to each and every use I may make of Rochester Athletic Club.
I have read this Release carefully and understand all of its terms and conditions. I sign it voluntarily and without reservations.
____________________________________________________________________________
Non-Member Signature (over 18)
How did you hear about the camp?





Post Bulletin Website
RAC website
RAC Schedule of Activities Booklet
Member
Member Name: _______________________
Other __________________
Camp Cancellation Policy:
1. If you cancel less than 8 days prior to the week of camp, the RAC will
keep $20.00 in administrative fees. If you are cancelling within the 8
days, you must call the appropriate camp director to cancel out of
camp, not the Activities Desk.
2. No refund once camp begins.
Please contact Anna Stroud, Neighborhood Director, with any questions or
comments at (507) 287-9307 or [email protected] Sign up at Activities Desk.
_______________________
Date
For camp definitions and for specific dates and times, please look up the camp in
the Rochester Athletic Club 2015 Spring/Summer Schedule of Activities available
online at www.racmn.com or pick one up at the Front Desk or Activities Desk.
“Summer Camp Important Information” form must be filled out in order for child
to participate in any camp. One form, per child, per camp needs to be submitted.
This form is available online at www.racmn.com or at the Activities Desk.
Please note: All camps must meet a minimum number of participants to run. If
the camp minimum is not met, the camp will be cancelled and you will be
contacted. If a camp needs to be cancelled due to low enrollment, these are the
days this will be determined:
Camp Start Day:
Camp Determination Made:
Monday
Friday
Tuesday
Monday
Wednesday
Monday
Thursday
Tuesday
Friday
Wednesday