Centenary University All-Sports Camp - 2016 ...
Centenary University All-Sports Camp - 2016 What: A unique camp that embraces physical play, variety, and athleticism rather than a focusing on a single sport. Campers will play traditional sports like basketball, flag football, soccer, and swimming in addition to athletic games like Capture the Flag, kickball, obstacle courses, Star Wars and many more. Every day will be an exciting mix of games that will foster fitness, teamwork, and fun. Who: Boys and girls. Ages 6-14. When: Monday, July 18- Thursday, July 21. 9am-2pm. Where: Meet daily in the Reeves Gymnasium Lobby on the Centenary University campus (715 Grand Ave. Hackettstown, NJ 07840). Cost: $200 for single camper. $150 for each additional camper. What to bring:
Athletic clothing/shoes Swim suit/towel Lunch Water bottle Great energy and attitude
Questions?
Contact Scott Kushner, [email protected], 908 852-1400x2344
----------------------------------------------------------------------------------------------Detach and return w/payment made out to: Scott Kushner, 400 Jefferson St., Hackettstown, NJ 07840
Camper #1:______________________________
Age: ____ DOB: ___ / ___ / ___
Camper #2:______________________________
Age: ____ DOB: ___ / ___ / ___
Address: _________________________ City: ___________________ St: ___ Zip: _______ Email: __________________________________
Phone: (______) _______ - _________
Sport/Game Requested (no promises, but we’ll try!): _____________________________ T-Shirt Size (adult): S
M L XL
Enclosed is my full payment for $___________
MEDICAL INFORMATION RELEASE FORM Mother’s Name ___________________________________ Day Phone ____________________Cell________________ Father’s Name Day Phone ____________________Cell________________ If Parents/Guardian cannot be reached, call __________________________
Phone _______________
__________________________
Phone _______________
Family Physician Name ___________________________________ Phone Number __________________________________ Please attach and explain any serious medical conditions and list the names of any medications the camper is presently taking and for what medical conditions. Allergic to Penicillin Aspirin Other ______________ Medical Insurance Co. _____________________________ Policy Number ___________________________________ Are you insured by any other health benefit plan such as an HMO, ETC. (Specify Plan) ________________________________________________ I hereby give permission for to participate in the Centenary University All-Sports Camp. I certify that my son/daughter is in good physical condition, has been examined within the last 12 months and no medical reason has been found that he cannot participate in this camp. Records show that all immunizations are up to date. I understand that he will be participating in rigorous play and activity. Centenary University Personnel have also been informed of any physical limitations, medications or prior conditions. The camp will safeguard the health of my child but will not be responsible for accidents, injuries or sickness on the way to camp, during camp, or on the way home. I agree that in the case of an accident involving my child while attending camp, and with full awareness that sports is an activity that may involve risk or injury, I release Centenary University and the staff of the Centenary University All-Sports Camp from any and all liability. I hereby request that my child be granted admittance into the Centenary University All-Sports Camp and authorize the directors to act on my behalf in the event of an emergency requiring medical attention. I will assume responsibility for payment for any such attention and have provided current insurance information as requested. By signing below, I agree to all the terms detailed above.
_________________________________________________ Parent/Guardian Signature
Date
Athletic clothing/shoes Swim suit/towel Lunch Water bottle Great energy and attitude
Questions?
Contact Scott Kushner, [email protected], 908 852-1400x2344
----------------------------------------------------------------------------------------------Detach and return w/payment made out to: Scott Kushner, 400 Jefferson St., Hackettstown, NJ 07840
Camper #1:______________________________
Age: ____ DOB: ___ / ___ / ___
Camper #2:______________________________
Age: ____ DOB: ___ / ___ / ___
Address: _________________________ City: ___________________ St: ___ Zip: _______ Email: __________________________________
Phone: (______) _______ - _________
Sport/Game Requested (no promises, but we’ll try!): _____________________________ T-Shirt Size (adult): S
M L XL
Enclosed is my full payment for $___________
MEDICAL INFORMATION RELEASE FORM Mother’s Name ___________________________________ Day Phone ____________________Cell________________ Father’s Name Day Phone ____________________Cell________________ If Parents/Guardian cannot be reached, call __________________________
Phone _______________
__________________________
Phone _______________
Family Physician Name ___________________________________ Phone Number __________________________________ Please attach and explain any serious medical conditions and list the names of any medications the camper is presently taking and for what medical conditions. Allergic to Penicillin Aspirin Other ______________ Medical Insurance Co. _____________________________ Policy Number ___________________________________ Are you insured by any other health benefit plan such as an HMO, ETC. (Specify Plan) ________________________________________________ I hereby give permission for to participate in the Centenary University All-Sports Camp. I certify that my son/daughter is in good physical condition, has been examined within the last 12 months and no medical reason has been found that he cannot participate in this camp. Records show that all immunizations are up to date. I understand that he will be participating in rigorous play and activity. Centenary University Personnel have also been informed of any physical limitations, medications or prior conditions. The camp will safeguard the health of my child but will not be responsible for accidents, injuries or sickness on the way to camp, during camp, or on the way home. I agree that in the case of an accident involving my child while attending camp, and with full awareness that sports is an activity that may involve risk or injury, I release Centenary University and the staff of the Centenary University All-Sports Camp from any and all liability. I hereby request that my child be granted admittance into the Centenary University All-Sports Camp and authorize the directors to act on my behalf in the event of an emergency requiring medical attention. I will assume responsibility for payment for any such attention and have provided current insurance information as requested. By signing below, I agree to all the terms detailed above.
_________________________________________________ Parent/Guardian Signature
Date
