Deposit Policy:

 The camp registration fee ($20/individual - $35/families) along with
a 25% non-refundable deposit is due when registering for camp.

Full payment is required two weeks prior to the start of camp unless
 you are enrolling your child for the entire summer and have arranged to
pay installments over the course of the program.

ELECTRONIC FORM

PRINTABLE FORM
Camp Ave Maria Registration Form-2012
Questions marked by * are required.
1. Child's Name(s) (First, Middle, Last) (If multiple campers from the same family are being registered please list them in age order; oldest to youngest)
2. Date(s) of Birth: (mm/dd/yy) (If multiple, please list oldest to youngest)
3. Camper's age(s) as of 6/1/2012:(for multiple children, please list in age order oldest to youngest)
4. Camper's Grade(s) in Sept. 2012: (If multiple, please list oldest to youngest)
5. Street Address:
6. City, State, Zip
7. Guardian #1 Name (First, Last):
8. Guardian #1 Relationship to Camper:
9. Guardian #1 Home Phone Number:
10. Guardian #1 E-Mail Address:
11. Guardian #1 Cell Phone Number:
12. (Leave the next 5 questions blank if only 1 guardian) Guardian #2 Name (First, Last):
13. Guardian #2 Relationship to Camper:
14. Guardian #2 Home Phone Number:
15. Guardian #2 E-Mail Address :
16. Guardian #2 Cell Phone Number:
17. Name and cell phone number of people other than guardian(s) who may be bringing your child to and from camp:
18. Name and cell phone number of neighbor or relative who can temporarily care for your child in case you cannot be reached:
19. Physician's Information: (Name, Address, Phone Number)
20. Allergies: Please list any allergies your child may have: (please indicate which child you are referring to)
21. Medications: Please list any medications your child may be taking and the reason for taking them: (please indicate which child you are referring to)
22. Dietary Restrictions: Please list any dietary restrictions your child may have: (please indicate which child you are referring to)
23. Conditions: Please list any chronic illness or medical conditions your child may have: (please indicate which child you are referring to)
24. Injuries: Please list any injuries or operations your child has or had: (please indicate which child you are referring to)
25. Special Needs: In order for our staff to ensure your child has a happy experience at summer camp, please share any special needs your child may have - e.g., learning disabilities, limitations, dislikes, fears etc...(please indicate which child you are referring to)
26. Please Choose Your Weeks: (There is a two week minimum.)
  • June 18-22
  • June 25-29
  • July 2-July 6 (no camp 7/4-makeup 7/9)
  • July 9-13
  • July 16-20
  • July 23-27
  • July 30-August 3
  • August 6-10
  • August 13-17
27. Extended Care: Extended care starts at 4:00pm and ends at 6:00pm and costs $4.00/flat-rate per day. You may use this service on an "as need" basis, however the charge for "as need " extended care is $4.00/per child/per hour and is due at the time you pick up your child. Please indicate your choice below:
  • I will need extended care on a daily basis
  • I may need extended care, but it will be on an “as need” basis
  • I will not need extended care at all
28. Please check appropriate registration fee:
  • single child-$20
  • family(2 or more campers)-$35
29. Camp Tuition Total: (to calculate your cost begin with the base tuition amount for the number of weeks you are enrolling your child for, then apply any discount(s) you are eligible for, add meal plan costs (if any), extended care costs (if any), and finally, add the appropriate registration fee. (Please call us if you have questions about pricing - 261-2606)
30. Payment Type:
  • MasterCard
  • Visa
  • Discover
  • American Express
  • PayPal
31. Name (as it appears on card):
32. Credit Card Number:
33. Expiration Date: (mm/yy):
34. Please type any comments or questions you may have into the box:
35. STATEMENT: I hereby certify that my child named herein is in normal health and capable of safely participating in this summer recreation program. I indemnify and hold harmless Ave Maria Dance Academy LLC, its owners, volunteers or employees and all involved with this program from liability for any harm that befalls my child as a result of his/her participation in it. In case of illness or emergency, I authorize the program director or assigned personnel to secure the services of a doctor and emergency treatment as necessary. I understand that medical information and personal data will be used only when necessary, to protect my child’s well-being. I have read and understand the Camp Ave Maria deposit/cancellation policy and I agree with the terms outlined therein. I agree that I and my child will adhere to all camp policies.
  • Please acknowledge your understanding and acceptance of the above liability waiver by checking this box.
36. Parent/Guardian Signature: (please type your name in the box below)
 
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