Georgia All-Star Gymnastics
Day Camp Enrollment – Summer
2008
Child’s
Name___________________________Nickname?______________
Parent/Guardian Name(s) Home# Cell# Work#
Age______Sex______Birthdate__________
Child’s
Address_________________________City_________Zip________
Lives With: Both Parents____
Father___Mother____Other_____
If your child needs special
medical consideration or medication please list (allergies, diet, medicine,
etc.) FILL OUT MEDICATION RELEASE
FORM.____________________________________________________________________________________________________________________
Do you give GASG personnel
permission to administer Children’s Tylenol or Advil, if needed? Yes/No
Does your child have any health
problems past or present of which we should be aware? Yes/No If yes, please
explain: _____________________________________________________________
Previous Injuries?_______________________________________________
GASG has my permission to
seek medical attention for my child, if necessary? Yes/No Health Insurance
Co.____________________________
Phone#_________________Policy
#_______________________________
In case of emergency and the
guardian(s) listed above cannot be reached please call the persons listed
below. All emergency numbers should be local, accessible, and include area
code.
Name
Home# Cell# Work#
The following person(s) MAY
NOT pick-up my child from Day Camp as per attached legal papers:
_____________________________________________________________
2008 Summer
I will need: Early Drop-off
(7-9am) Yes No
Late Pick-up (5-6pm) Yes No
NOT
INCLUDED
IN
Week of
May 27th : ˝ Days Full Days UNLIMITED
M T W
TH F PRICE
_____________________________________________________________
Week of June 2nd: ˝ Days Full Days
M T W TH F
Week of June 9th: ˝ Days Full Days
M T W TH F
Week of June 16th: ˝ Days Full Days
M T W TH F
Week of June 23rd: ˝ Days Full Days
M T W TH F
Week of June 30th ; ˝ Days Full Days
M T W TH F
Week of July 7th: ˝ Days Full Days
M T W TH F
Week of July 14th : ˝ Days Full Days
M T W TH F
Week of July 21st : ˝ Days Full Days
M T W TH F
Week of July 28th:
M T W TH F___________
NOT
INCLUDED
Week of August 4th
: ˝ Days Full Days UNLIMITED
M T W
TH F PRICE