EmailMe Form - 2011 OBYG BIG Sports Camp Application

EmailMeForm

Childs Name *
First Last
Gender *
Home Mailing Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region
Home Phone Number *
### - ### - ####
Email *
Fire Island Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region
Fire Island Phone *
### - ### - ####
Best Day Time Phone *
### - ### - ####
Mother's/Guardian's Name
First Last
Father's/Guardian's Name
First Last
Emergency Contact Name *
First Last
Emergency Contact Phone *
### - ### - ####
My child will be attending OBYG Big Kick Sports Camp during: *
Additional Information:

1. A $230 or $110 payment is required with each application for a child that is attending for the entire week. This payment should be submitted at the OBYG camp office no later than FRIDAY, AUGUST 19, 2011.

2. A $15 administrative fee will be added for those who register on the first day of a camp session.

3. A daily rate of $80 for morning or afternoon sessions and $40 for the evening session is available.
Parent/Guardian Initials (in caps) *
Date *
All forms should be submitted no later than August 19,2011 in order to avoid the administrative fee of $15.
I understand that this is only a camper application form, and that I am responsible for submitting a payment in order to complete the registration process. In addition, I assure that my child is in good health and able to participate in all activities associated with the camp. My typed initials and the date above illustrate this understanding. *
Yes, I understand.
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