EmailMe Form - Summer Camp @ Spoga Fitness Center

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Child's Name

First Last

Sibling's Name

First Last

Age of child (children)

Parent's Name

First Last

Phone

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

Email

Address

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

Emergency Contact (Name)

First Last

Emergency Contact Phone #

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

Select Camp Sessions

June 10-14, 2024

July 15-19, 2024

Person(s) authorized for pickup: *

Please list any allergies, health conditions or concerns we would should be aware of:

Campers can bring a packed lunch daily or the Power Bar can provide your child lunch for the week. Lunch items include grilled cheese, ham sandwich, peanut butter & honey sandwiches. Snacks include fresh fruit, yogurt, popcorn, gold fish, etc. Drinks: water & Powerade. *

My child will bring lunch from home

I would like to sign up for Power Bar Lunch & Snacks ($80/week)

If you would like to participate in Power Bar Lunch, please select the item they would like to have for daily lunch

Ham & Cheese Sandwich

Peanut Butter & Jelly Sandwich

Grilled Cheese

Please list any medications being used & list any medications needed during summer camp:

I hereby release and agree to defend, indemnify and hold harmless Spoga, Inc. their owners, employees, agents, insurers, and assigns from any liability or damages of any kind which may arise from the administration of medication to my child as authorized herein. Should my child require medical treatment, I hereby authorize the Camp Directors to consent to medical treatment on behalf of my child, and to notify me as soon as possible thereafter. I hereby release and agree to defend, indemnify and hold harmless Spoga, Inc., their owners, employees, agents, insurers and assigns from any liability or damages of any kind which may arise from consenting to medical treatment as authorized.

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CONSENT FORM AND LIABILITY WAIVER RELEASE

In order for your child to attend Spoga’s Camp, this consent form and liability waiver must be signed by the camper’s parent or legal guardian.

A. I hereby give my consent for my child to attend Spoga’s Camp. In consideration of the acceptance of the below named minor and on behalf of myself, my child named herein, or our heirs, successors or assigns, I hereby release, waive and agree to defend, indemnify and hold harmless from any claim, loss, liability, damage, expense, or cause of action which may accrue against Spoga, Inc., their owners, employees, agents, insurers or assigns, or any person acting with their permission or authorization arising out of any injury to the minor or loss of damage to any property of such minor during his/her stay at camp, in transit to and from camp, or during any camp activity or that may occur from my child’s participation in Spoga’s Camp.

B. I hereby give permission to Spoga, Inc. to transport my child off Spoga Fitness Center grounds to local sights for extracurricular activities. I understand my child will be walking on the public side walk to the movie theatre with a police escort and all camp counselors for the field trip to the AMC Movie Theatre.

C. I realize and authorize that photographs, videos, written extractions and voice recordings of my child may be taken during various activities for purpose of illustrations, publications, websites, blogs, and other purposes. I hereby authorize and give full consent to Spoga, Inc., to publish and copyright all photographs, videos, written extractions, and voice recordings in which my child appears while he/she is participating in any camp program. I acknowledge that I will not be informed or reimbursed for any such usage.

D. I hereby give my permission for the camp director or a representative authorized and designated by the camp director of Spoga’s Camp to obtain emergency medical/dental care for my child in the event of such necessity. I understand that I will be financially responsible for any such medical/dental service given to my child.

E. I understand and consent that Spoga, Inc., reserves the right to search my child’s belongings and I hereby authorize such searches and I hereby release and agree to defend, indemnify and hold harmless Spoga, Inc., the owners, employees, agents and assigns from any liability or damages of any kind which may arise from any such search. *

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Credit Card Authorization Form

Registration due at time of sign up ($50 per child)

Card on file will be charged amount for registration at time of form submission.

Summer Camp fee due 1 week before camp:
$230/ members
$265 non-members
$25 sibling discount available *

For questions or immediate assistance, please send text to our Membership Team.
985-345-2453
All accounts are managed by Spoga Fitness Center.