Registration Form

Location: Vince's Sports Center 14 Gender Rd Newark,DE 19713

Includes: Breakfast,Lunch, PM snack, Club T-shirt, fun activites, leadership lessons and so much more!

Fridays Include a little extra! Campers recieve 45 tokens for game room and PIZZA!!!

Notes: Drop-off is 9am Pick up is no later then 3pm. All Children should be accompanied by parent/guardian no later then 3pm.

Please be advised: you will be billed $30hr for services provided after 3pm. After camp services are expected to be paid in full prior to campers participation.

Admission is subject to avilability- WE will contact you after we review your application to complete admission process.

Approved Applications will be contacted- Camp Care Package will be distributed upon PAID IN FULL STATUS
Vince's Sports Center

2023 Spring & Summer
Youth Leadership Camp

Young Leaders in Change!!
Payment Details

Cost $400=one FULL WEEK 9am-3pm $300=one FULL WEEK (HALF DAY ) 9am-12pm Payments are made to Vince Sports Center - Upon Application Approval -- 50% deposit non refundable is expected upon admission Payment in full one week prior to camper starting

Please select week of interest:*

Rows	Full-Day 9am-4pm	Half-Day 9am-1pm	1 Day-Pass 9am-4pm
Spring Break April 10-April 14
Summer Break Week 1 June 19 - June 23
Summer Break Week 2 June 26 - June 30
Summer Break Week 3 July 17 - July 21
Summer Break Week 4 July 24 - July 28
Summer Break Week 5 July 31 - August 4
Summer Break Week 6 August 14 - August 18
Summer Break Week 7 August 28 - September 1

Campers Information
Camper Name*

First NameLast Name
Gender*
Age*
Date of Birth*

MonthDayYear
Date
Grade/Level*
School Name
Extra SmallSmallMediumLargeExtra Large
Medical/Additional Information

Please Share any information that can help us support your child
Do you have any personal or educational concerns for your camper? *
Please let us know if camper has any allergies, existing illnesses or any medical conditions.*

Any additional information that will be helpful for us to know about your camper? *
Parent/Guardian Details
Parent/Guardian Name*

First NameLast Name
Phone Number*

Cell Home/Other
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Details

If parent/guardian cannot be reached. Please List at least 2 contacts
Contact Name*

First NameLast NameRelatioship
Phone Number*

CellHome/Other
Contact Name*

First NameLast NameRelationship
Phone Number*

CellHome/other

Acknowledgment, Authorization, and Waiver

Please Read and Sign Below that you acknowledge and Read all information.
This child has my authorization to engage in the activities of this Camp. I allow taking photography of this student that can be used for B7edu Foundations and Vince's Sports Center portfolio or advertising. I authorized B7edu Foundation and Vince's Sports Center to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if they are unable to contact the parent/guardian. I allow them to apply first aid, medical or surgical diagnosis and treatment as necessary. I allow B7edu and Vince's to provide or administer the medication or supervise in self-administration. I release B7edu Foundation, Vince's Sports Center and any of its mentors, staff, and volunteers for any responsibility in case of accident, illness, or injury during this students participation.
Enrollment will be based on availability.

This document is for informational purpose only it does not guarantee a spot . Please have registration complete filled out and submitted as early as possible and one of our team members will contact you. NOTE: SPOTS ARE LIMITED
Date Signed

MonthDayYear
Date
Parent/Guardian Signature

Clear
Partners in Change!

B7edu Foundation + Vince's Sports Center

"BE THE CHANGE YOU WISH TO SEE IN THE WORLD"

Email:Bendetta.Quindlen@b7edu.com CALL:(302)268-3408
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Vince's Sports Center