EmailMeForm
Summer Camp 2017 -Hialeah Miami Lakes HS
PARENTS INFORMATION
Mothers Name
*
Fathers Name
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Cell Phone Number #1
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Cell Phone Number #2
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Email #1
*
Email #2
Are you a School Teacher?
Yes, I am a teacher
No
If so, What School do you teach in?
Do you own a business?
Yes
No
Local Business Networking Opportunity
How many Children are you signing up?
*
Only One Child at the Hialeah Miami Lakes HS Location ($50 reg. + First week $80)
Yes, Registration for Two Children at the Hialeah Miami Lakes HS Location ($100 reg. + First week $150)
Yes, Registration for Three Children at the Hialeah Miami Lakes HS Location ($150 reg. + First week $220)
First payment will include: Registration Fee ($50) per child + the first week selected below
The FIRST week attending Camp?
*
Please select
Week 1: Monday June 12th - Friday June 16th
Week 2: Monday June 19th - Friday June 23rd
Week 3: Monday June 26th - Friday June 30th
Week 4: Monday July 3rd - Friday July 8th*
Week 5: Monday July 10th - Friday July 14th
Week 6: Monday July 17th - Friday July 21st
Week 7: Monday July 24th - Friday July 28th
Week 8: Monday July 31st - Friday Aug 4th
Week 9: Monday August 7th - Friday Aug 11th
Week 10: Monday August 14th - Friday Aug 18th
Please list the people that will collect your child at the end of the day.
(Name / Phone number / Relation to your child)
PLEASE NOTE: the above listed people will need to provide ID
CHILD #1 INFORMATION
#1: Child's Full Name
*
#1: Date of Birth
*
#1: School Name
#1: Grade
*
CHILD #2 INFORMATION
#2: Child's Full Name
#2: Date of Birth
#2: School Name
#2: Grade
CHILD #3 INFORMATION
#3: Child's Full Name
#3: Date of Birth
#3: School Name
#3: Grade
INSURANCE
Do you need ALM Sports Insurance?
ALM Insurance cost $10 per week
*
Yes, ALM Sports Insurance
No
Will cover one week, per family of 3
Primary Insurance Details
(your childs insurance carrier and policy number)
Medical Concerns
Food Allergies
REFERRALS
Who Referred you?
Please put their Name & Cell#
NOTIFICATION
How Did you hear about ALM Sports Summer Camp?
*
Previous Camper
A Friend told me
Flyer at my childs school
Received an Email
Flash Sale Email
Received a sms Text message
Facebook Ad
Instagram Ad
Looked up on Google / Bing
Refer a friend
Are you able to provide a referral information?
*
Please select
I have NO Referrals
I will list only One Referral
I will list Two Referrals
receive $5 discount off your Registration Fee, if you refer two family members or Friends or co-workers
#R1: Name
First
Last
#R1: Phone
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#R1: Email
#R2: Name
First
Last
#R2: Phone
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#R2: Email
Monthly Discounts
Monthly Discounts
Please select
March 2017 ($15 off Registration)
April 2017 ($10 off Registration)
May 2017 ($5 off Registration)
TERMS & CONDITIONS
I have read and agree to the Terms of Service
*
Yes, I agree.
If your child is covered by a private insurance, you must provide us with proof of your child’s insurance coverage. If your child is not We offer this through WestPoint Insurers at a cost of $10.00 for up to 5 days during the Summer camp. I give consent for my child to take part in the activity and consent to emergency treatment as necessary. I accept that the organizers and their employees are not under any liability whatsoever in respect of injury, loss or damage whilst on the course, other than imposed by law. I also allow ALM Sports to take photos for advertising and promoting purposes only; if you do not want your childs photo to be taken please email admin@almsports.com. I confirm that my personal insurance is correct and bears responsibility in case of accidents. I confirm that I am legally entitled to give this consent and understand all payments received are non-refundable.
I agree and understand that all payments are non-refundable
*
Yes, I agree.
Total
$0.00