Summer Camp Registration

* Please enter the camper's first and last names and their ages below.

* What is the complete date of birth of the Campers? (Month/Day/Year)

* What are the names of the Campers parents or guardians? Please provide first and last names.

* What is the Campers home phone number?

* If we need to reach you on your cell phone, what is your cell phone number?

* If you have a preference for which email address we use as an emergency contact, what is that preferred email address?

Do the Campers have any allergies? If so, please describe them here and any related information we should be aware of.

Is the Camper on any medication we should be aware of? If yes, please describe here.

* Administration of medication will be performed by the staff. Parents must complete a medication form for medicines to be given on a regular basis. Medications necessary for short term basis only must be accompanied with a signed written directive indicating dosage and time for administration.
Should a camper become ill, the supervisor will attempt to make phone contact with persons listed on the camper’s Emergency Contact Sheet. For emergency situations requiring immediate medical attention, Jones County Rescue will be contacted. Parents should indicate their hospital of choice at the time of registration in the event of necessary emergency transportation.
Please sign and date below indicating that you agree to these terms.

* Children will be disciplined according to the severity of the misbehavior. Actions will include: verbal warnings, loss of privileges (5-10 minutes), parent conferences, suspension or removal from the program. The discipline measure taken will be at the discretion of the staff member involved, and the Program Director. The Director may immediately suspend a child at anytime should the child’s behavior become extremely harmful to the staff, children or him/herself.
Behaviors that may result in immediate suspension or removal from the program include:
-Any type of fighting
-Intimidating, harassing or threatening others
-The use of profane language, gestures or behaviors
-Leaving the camp area without supervision of a staff member
-Defacing or damaging property of Gray-8-Skate, other campers or staff .
It is understood that chronic misbehavior could result in the termination of services from the camp.

* Campers must be signed in and out daily by a parent or authorized person. Campers may be picked up or dropped off anytime during our operating hours. Campers will only be released to parent/guardian and/or people specifically authorized on student information sheet. Children may NOT sign themselves in or out. For the safety of your child, individuals may be required to show proof of ID at anytime.
If special consideration/concerns regarding pick up exist, the parents should notify the supervisor in advance of the situation and should complete a “Special Pick Up” form. Custody concerns should be discussed with administration and proper legal papers provided.
All children must be picked up by 6:00 P.M. A late fee of $1.00 for every minute late will automatically be charged to the parent’s/guardian’s tuition account. A fee of $10.00 plus $1.00 per minute is added after first late pick up.

List the number of children and their names below who you are registering for a minimum 8 week camp. Weekly Rates: $100.00 for the first child; $85.00 for the second child; $70.00 for the third child. Additional $15 for breakfast snack, lunch and afternoon snack, if needed.

Times: 7:00 AM - 6:00 PM, When: May
29 – July 31, 2018 , Payment Dates: Monday of each service week (you may pay early)
{Camp services will be discontinued if payment is not made by the following Monday morning for the specified week of services. This program will not be able to operate a “charge system” for services.}
The contracted fees, as defined above, allow for supervision from the hours of 7:00 A.M.-6:00 P.M. Parents registering for the contracted agreement will be bound by the fees for the contract period once registration is complete. Personnel will be hired based on the number of contracted families participating in the program. ALL SPACE IS LIMITED SO PLEASE RETURN COMPLETED REGISTRATION FORM AS SOON AS POSSIBLE REGARDLESS
OF SERVICE REQUIRED

Please enter the number of children and their names below who you are registering for a minimum 4 week camp commitment. Weekly Rates: $125 for the first child; $110 for the second child; $95 for the third child.
Additional $15 for breakfast snack, lunch and afternoon snack, if needed.
Payment Dates: Monday prior to the service week (you may pay early).

Please list the number of children and their names who you are signing up for a minimum 1 week camp commitment below. Weekly Rates: $135.00 for the first child; $120.00 for the second child; $105.00 for the third child. Additional $15 for breakfast snack, lunch and afternoon snack, if needed.

Payment Dates: Monday prior to the service week (you may pay early)

Please enter the number of Drop Off Days you would like below.
Daily Rates: $30.00 per day per child
Payment Dates: Payment is due at the time of student drop off on the day services will be rendered. Spaces for drop off services are not guaranteed. Services will be provided on a first come first serve basis. Parents may wish to phone ahead to verify if spaces are available on any given day. Reimbursements cannot be given for partial hours.

* Please indicate which weeks your child(ren) will be attending Gray-8-Skate Summer Camp from the drop down below. By selecting these you are agreeing to pay for the designated weeks.

* The Participant and/ or their parent(s) or guardian understands, acknowledges, and agrees that roller skating is an inherently dangerous and physically demanding activity. Participating skater assumes full responsibility for any risk of injury, property damage, or death while participating in activities at this establishment.
Participant and/ or their parent(s) or guardian hereby waive any and\all claims including, but not limited to: bodily injury including death and property damage they may have against GRAY-8-SKATE (its parents, subsidiaries, partners and affiliates) and all sponsors of the roller rink and their
subsidiaries, affiliates, partners, officers, directors, employees, agents, and volunteers from arising out of Participant’s use of the Roller Rink and all surrounding areas.
Participants and/ or their parent(s) or their guardians hereby release and hold harmless GRAY-8-SKATE (its parents, subsidiaries, partners and affiliates) and all sponsors of the Roller Rink and their subsidiaries, affiliates, partners, officers, directors, employees, agents, and volunteers from any and all
liability for any loss, damage, or expense that the Participants or their respective heirs, assigns and legal representatives may suffer as a result of Participant’s use of the Roller Skating Rink, from any cause whatsoever, including but not limited to, negligence or breach of contract on the part of
GRAY-8-SKATE (its parents, subsidiaries, partners, and affiliates, and all sponsors of the Roller Rink, in the operation, supervision, design, maintenance, or condition of the synthetic surface, or of the Roller Rink and all surrounding areas.
Participant permits GRAY-8-SKATE , its parents, subsidiaries, partners, and affiliates to use any photographs, videotapes, recording or any other records taken while on the synthetic Roller Rink for publicity, advertising, or any other legitimate purpose, without compensation to the Participant.
BY SIGNING THIS RELEASE OF LIABUILTY AND WAIVER OF ALL CLAIMS, I UNDERSTAND THAT I AM RELEASING GRAY-8-SKATE ROLLER RINK FROM ANY CLAIMS FOR NEGLIGENCE AND DAMAGES CAUSED BY GRAY-8-SKATE NEGLIGENCE AND AGREEING TO THE OTHER TERMS IN THIS DOCUMENT.
BY SIGNING I ALSO AGREE TO PAY FOR ANY DAMAGES CAUSED TO EQUIPMENT CAUSED BY ABUSE OR MISUSE IN A CASH AMOUNT OF NO LESS THAN $10.00 (THIS INCLUDES SKATING ON SURFACES OF THE ROLLER RINK). I HAVE CAREFULLY READ THIS WAIVER, RELEASE OF LIABILITY AND
ASSUMPTION OF RISK AGREEMENT IN ITS ENTIRETY AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A WAIVER, RELEASE OF LIABILITY, ASSUMPTION OF RISK AGREEMENT AND A LEGAL CONTRACT BETWEEN ME AND GRAY-8-SKATE AND THAT IT AFFECTS MY LEGAL RIGHTS.

I AM SIGNING THIS DOCUMENT OF MY OWN FREE WILL. A PHYSICAL AND ELECTRONIC COPY OF THIS DOCUMENT IS AUTHENTIC AND IS AS EFFECTIVE AS THE ORIGINAL AND DOES NOT EXPIRE.

Participants must be at least 18 year-old or have parent or guardian sign below on their behalf

* Notice of Exemption:
I acknowledge that I have been informed that this program is not a licensed child care facility. I also understand this program is not required to be licensed by the Georgia Department of Early Care and Learning and this program is exempt from state licensure requirements.

Please use this space to let us know any additional comments, questions or requests you have that will make this event extra special.

* Have you ever hosted or attended a group event at our facility before?

* Can you tell us how you first heard of us?