DELAWARE SOCCER CAMPS 2010 Day Camp Registration and Medical Form
Camper First Name:
*
Camper Last Name:
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Year
Grade Fall (2010)
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*
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Female
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T-Shirt Sizes (Youth)
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YS
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We will be offering 3 weeks of Day Camps this summer! Weeks One, Two and Three of DSC Day Camps at University of Delaware from 9am - 3pm for boys and girls 6-12 years of age. These camps include 1 hour of time in the UDEL outdoor pool. The CAA Soccer Day camp will be held at the CAA Soccer Rex Plex in Newark from 9am-1pm for boys and girls 6-12 years old. This camp does not include pool time or have after hour care available. Our TOTS Camp will run during the same week at the same location as the CAA Camp for boys and girls aging from 3 to 6 years.
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DSC Wk 1 - June 14-18
$195.00
$
195.00
DSC Wk 2 - June 21-25
$195.00
$
195.00
CAA Camp - July 26-30
$150.00
$
150.00
WK 1 w/ Multi/Sibling Discount
$185.00
$
185.00
WK 2 w/ Multi/Sibling Discount
$185.00
$
185.00
CAA w/ Multi/Sibling Discount
$140.00
$
140.00
WK 1 w/ Team Discount
$180.00
$
180.00
WK 2 w/ Team Discount
$180.00
$
180.00
CAA w/ Team Discount
$135.00
$
135.00
After Hours (DSC Wk1/Wk2/Wk3 ONLY)
$75.00
$
75.00
DSC Wk3 - June 28 - July 2
$195.00
$
195.00
WK 3 w/ Multi/Sibling Discount
$185.00
$
185.00
WK 3 w/ Team Discount
$180.00
$
180.00
TOTS Camp July 26-30
$79.00
$
79.00
TOTS Camp w/ Multi/Sibling Discount
$69.00
$
69.00
Total
$0.00
$
0.00
Online registration requires full payment at time of registration. Any cancellations will incur a $75 application fee. If paying by check at $75 non-refundable deposit is due at the time of registration. Full payments are due by May 31, 2010. Registrations after May 31, 2010 will require full payment.
** Discounts cannot be combined
***CHECK BELOW IF SUBMITTING A CHECK BY MAIL ONLY!***
Please choose week(s) desired:
DSC Wk1 June 14-18 ($195)
DSC Wk2 June 21-25 ($195)
DSC Wk3 June 28 - July 2 ($195)
CAA Camp July 26-30 ($150)
TOTS Camp July 26-30 ($79)
Discounts/Additional Services Offered: Choose if applicable
$10 Multi-Week Discount (Off 2nd Week)
$10 Sibling Discount (off each child)
$15 Team Discount (8 or more players)
$75 After Hour Care (3pm-5pm DSC Wk1, Wk2 & Wk3 ONLY)
** Discounts cannot be combined
COMMENTS or Special Requests:
Medical and Contact Information Required
Mother's First Name
*
Mother's Last Name
*
Mother's Day Phone
Mother's Cell Phone
Father's First Name
*
Father's Last Name
*
Father's Day Phone
Father's Cell Phone
IF PARENTS/GUARDIANS CANNOT BE REACHED, PLEASE CALL THE FOLLOWING:
Emergency Contact #1 Name/Phone Number
*
Emergency Contact #2 Name/Phone Number
Family Physician Name
*
Family Physician Number
*
IN THE BOX BELOW, PLEASE EXPLAIN ANDY SERIOUS MEDICAL CONDITIONS AND LIST THE NAMES OF ANY MEDICATIONS THE CAMPER IS PRESENTLY TAKING AND FOR WHAT MEDICAL CONDITIONS
Medical Conditions
Allergic to
Penicillin
Aspirin
Latex
No Known Allergies
Other Allergy
Medical Insurance Company
Policy Number
Are you insured by any other health benefit plan such as an HMO. Please specify
The above Camper has been examined within the last 12 months and no medical reason has been found that he/she can not participate in this camp. Records show that all immunizations are up to date.n
I agree that In case of an accident involving my child while attending camp and with full awareness that soccer is an activity that may involve risk or injury, I release Delaware Soccer Camps and the University of Delaware from any and all liability. In case of an emergency, I give permission to have my child properly transported to a medical facility for care. I understand that Delaware Soccer Camps and the University of Delaware do not provide medical insurance and that I will be responsible for all medical expenses incurred. Delaware Soccer Camps has established the following procedure for injury or sickness: (1) the camp will call home. (2) call the father’s, mother’s or guardian’s place of employment, (3) call the emergency numbers and physician, (4) call an ambulance if necessary for transportation to medical facility, (5) attending physician will make judgment of admittance, (6) Delaware Soccer Camps will continue to call parents , guardian or physician until one is reached. If I cannot be reached and the camp has followed the above procedures, I assume all expense for the transportation and medical treatment. I also hereby consent to any treatment, surgery, diagnostic procedure, or the administration of anesthesia which may be carried out based on the medical judgment of an attending physician.
Medical Waiver
*
I Agree to the terms detailed above
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