EmailMe Form - Summer Camp 2019 -Hamden CT

How Did you hear about ALM Sports Summer Camp 2019? *

PARENTS INFORMATION

Mothers Name *

Fathers Name *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Mother's Cell Phone Number #1 *

### - ### - ####

Father's Cell Phone Number #2

### - ### - ####

Mother's Email #1 *

Father's Email #2

Are you a School Teacher?

Yes, I am a teacher

No, I am not a Teacher

If so, What School do you teach in?

Do you own your own business?

Yes, I own a Business

No, I do not own a business

Local Business Netwoking Opportunity

How many Children are you signing up? *

Only One Child at the Hamden CT - Monkey Joe's ($50 reg. + First week $100)

Yes, Registration for Two Children at the Hamden CT - Monkey Joe's($100 reg. + First week $190)

Yes, Registration for Three Children at the Hamden CT - Monkey Joe's ($100 reg. + First week $290)

First payment will include: Registration Fee ($50) per child (first 2 children) + the first week selected below

The FIRST week attending Camp? *

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 *

The Grade Going Into

What is the duration of your first child? *

What is your child's t-shirt size?

CHILD #2 INFORMATION

#2: Child's Full Name

#2: Date of Birth

#2: School Name

#2: Grade

The Grade Going Into

What is the duration of your second child?

What is your child's t-shirt size?

CHILD #3 INFORMATION

#3: Child's Full Name

#3: Date of Birth

#3: School Name

#3: Grade

The Grade Going Into

What is the duration of your third child?

What is your child's t-shirt size?

INSURANCE

Do you need ALM Sports Insurance?
ALM Insurance cost $10 per week *

Yes, ALM Sports Insurance

No additional Insurance needed (ill use my Primary Insurance)

Will cover one week, per family of 3

Primary Insurance Details
(your childs insurance carrier and policy number)

Medical Concerns

Food Allergies

Notice of Non-Administration of Medication *

Yes, I understand

I, the parent/guardian of the child(dren) in this registration, who attends the ALM Sports Summer Camp program in Monkey Joe’s – Hamden, CT understand that ALM Sports Staff members are not trained or license in the medical field and therefore are not able to administer my child with any medication (over the counter or prescribed) at the camp location.

I understand that it is my responsibility to administer my child’s prescribed medications before or after my child attends camp.

Name the Person Who Referred you?

or the name on the flyer you received

Refer a friend

Are you able to provide a referral information? *

receive $5 discount off your Registration Fee, if you refer two family members, Friends or co-workers

#R1: Name

First Last

#R1: Phone

### - ### - ####

#R1: Email

#R2: Name

First Last

#R2: Phone

### - ### - ####

#R2: Email

Monthly Discounts

ADDITIONAL SUPPLIES - Optional

#1: ALM Educational Booklet to take home

ALM Provides individual work sheets from these booklets everyday at camp; but you want to purchase a full booklet of your Childs grade to take home - you can here.
Buy Now for only $8.
or $10, If you decide to purchase at camp.

Do you want to purchase the additional take home educational workbook? *

Yes, purchase workbook now

No, not buying workbook

#2: EXTRA: Camp Shirt
*you will only receive your specific camp color

Please Note: Your Child will receive a Free Camp Shirt on the first day of Camp.
Incase you wanted an additional shirt and/or if you lose or damage your shirt.
Buy Now for only $8.
Or $10, if you decide to purchase at Camp.

Do you want to purchase another Camp Shirt? *

Yes, Purchase another Camp Shirt Now

No, not buying another camp shirt

#3: EXTRA: drawstring bag

Please Note: Your Child will receive a Free drawstring bag on the first day of Camp.
In case you wanted an additional bag and/or if you lose your bag.
Only $5, if you purchase now;
or $8 if you decide to purchase at camp.

Do you want to purchase another drawstring bag? *

Yes, Purchase another bag now

No, not buying another bag

#4: EXTRA: Water bottle

Please Note: Your Child will receive a Free Water Bottle on the first day of Camp.
In case you wanted an additional bottle and/or if you lose your bottle.
$4 if you purchase now.
Or $7, if you decide to purchase at Camp

Do you want to purchase another Water Bottle? *

Yes, Purchase another water bottle now

No, not buying another water bottle

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.