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Camp Enrollment  
 
Summer Camp Enrollment Application
 
Please submit one enrollment form for each child.
 
     
  Mother’s Name
     
  Father’s Name
     
  Home Phone
     
  Address
     
  City
     
  State
     
  Zip
     
  Email address
     
  Father’s Employment
     
  Work Number
     
 

Cell#

     
  Mother’s Employment
     
  Work Number
     
  Cell#
     
  Child’s Information
     
  Child’s Name
     
  Age
     
  Grade (ex: rising 2nd)
     
  Camp Enrollment Level Splash (Preschool - Morning)
    Fit2Splash Half Day Camp
    Breezers (1 – 3 grade)
    Summer Sun Crew (4 – 6 grade)
    Rural Hill / HFFA (Rising 1st - 5th grade)
     
  Is your child on any medication? YES NO
  If yes, what?
     
  Is your child up to date on shots? YES NO
     
  Is your child allergic to any medication? YES NO
  If yes, what?
     
  Does your child have any food allergies? YES NO
  If yes, what?
     
  Please list any other allergies
 
     
  Please list any other medical conditions
 
     
  Person responsible for paying for childcare
 
     
  Persons responsible for picking up child/relationship to child
 
     
     
  Emergency Care Information
     
  Name of child’s doctor
     
  Office Phone
     
  Address
     
     
  Name of child’s dentist
     
  Office Phone:
     
  Address
     
     
  Hospital preference
     
  Phone
     
     
  If neither father nor mother (or guardian) can be contacted, call:
     
  Name
     
  Home Phone
     
  Office
     
  Relationship to Child
     
     
  Name
     
  Home Phone
     
  Office
     
  Relationship to Child
     
     
  Emergency Action Release and Consent to Treat
     
 
I give HFFA and the Summer Camp team members permission to treat or authorize treatment on behalf of my child in the event emergency medical care is needed. I understand that when possible, every attempt will be made to reach me or my emergency contacts prior to treatment. I understand that HFFA and it’s employees will call for and authorize emergency care in my absence if necessary.
     
  Please note:  
     
 
  • Registration fees will be collected at time of registration.
  • Non-refundable 10% deposit required for each week signed up for at time of registration.
  • Weekly automatic drafts are required for all campers.
  • Weekly payments will be automatically drafted each week on the Friday prior to the week your child is attending.
  • Payments are for full weeks only, we do not prorate camp dues. If your child misses a day you must still pay for the full week of camp.
  • If you have 2 children attending camp you will receive a $20 discount on each additional child attending camp (For children split between Preschool camp and Traditional camp the Preschool camper will be discounted).
  • There is a $1 per minute late fee assessed when your child is picked up late. You will be required to sign acknowledgement of this and it will be charged with your next week’s tuition.
  • Two weeks notice must be provided if you are unable to attend camp or you will be charged even if your child does not attend.
  • All families must complete a drafting form.
     
 
I understand the above stated and agree to follow the payment procedures listed.
     
  For questions on your application and confirmation of application & registration status, how would you like to be contacted?
   
     
  Verification Code verification image, type it in the box
     
  Type Verification Code
     
   
     
 
 
 
 
 
 
704.766.2222 | 11725 Verhoeff Drive | Huntersville, NC 28078 | ©2008 Huntersville Family Fitness & Aquatics. All Rights Reserved | Site designed and maintained by Breiding Marketing