Summer Camp Registration- TAZEWELL PIKE

Ages 5-12 years old

(may be 4 if starting Kindergarten in 2022)
- May 30-June 2nd : Spirit Week: Enjoy a week full of suprises when each day is a different wacky theme! Will it be crazy hair day? Decades day, or Tacky Tuesday? Sign-up to find out! NO CAMP MEMORIAL DAY
- June 5-9th: F is for Fitness: This week will be full of activities for all fitness levels! We will learn about getting in shape, muscle groups, and maintaining physical fitness! it will be intense , but loads of FUN! Campers will experience circuits, obstacle courses, relays and participate in Kids in Motion classes!
- June:12-16th: Myth Busters: Campers will spend the week solving the curious questions of the world. It's NO myth this week with be a blast!
- June 19-23rd: Let the Games Begin: Is your team fierce? Bring out the competitive edge while having fun! This camp is a blend of classic lawn games, field day competitions, and absurd head-to-head relays you can't even begin to imagine!
- June 26-30: Under the Sea: Join us for a week of hands-on exploration as we learn about fish, creatures, and other life under the sea. Camp activities will include art, science, outdoor time, nature, movement,and SWIMMING!
- *July 3-7:Holidaze!: Jingle Bells, Batman Smells.. I pledge alligence to the flag... prepare to celebrate all your favorite holidays in just 1 week! NO camp on JULY 4th!
- July 10-14th: Back to the Drawing Board: Unleash your inner Van Gogh this week as your learn different art techniques,skills,and learn to create your own masterpieces!
- July 17-21st: NFC Olympians: Train like an Olympic Athlete! Campers will work through different obstacles to improve skills in Olympic events including track and field, gymnastics, and swimming!
- July 24-28th: Knights and Princesses: Where did all the fairytale creatures go? Come search with us! Campers will go on a quest to battle dragons, meet fairies, and save the day!
- July 31-Aug 4th: Back to School Bash:Ready, Set, Go! This week is all about celebrating the end of summer and welcoming a new school year. Each day will be a new theme and full of high-energy activities.

Monday-Friday 8:30 a.m.- 5:30 p.m.

EARLY DROP OFF AVAILABLE BEGINNING AT 7:30AM FOR ADDITONAL FEE. Campers must be picked up by 5:30 pm. There will be a $1 per minute fee assessed for every minute after 5:35 pm. This late fee is charged per camper.
Camp Fees are due 2 weeks prior to the start of camp.
MEMBER

FULL-TIME: $155 DAILY: $35

*Memorial Day and 4th of July Camp Weeks will be prorated
NON-MEMBER

FULL - TIME: $175 DAILY: $40

*Memorial Day and 4th of July Camp Weeks will be prorated.
REGISTRATION FEE

(1X FEE PER SESSION)

$69.95/CAMPER $165/3 CAMPER HOUSEHOLD
BEFORE CARE (7:30a.m.- 8:30 a.m.)

Weekly: $25/camper 3+ camper household: $50 Day: $5/camper

Camper 1 Name*
Age*
Date of Birth*

MonthDayYear
Date
T-Shirt Size*
NOTE - Children need to be entering Kindergarten and cannot be over the age of 12 to be eligible to participate in day camp. Please contact the Summer Camp Director or Children's Director for more information.
Camper Swimming Ability*

Non-SwimmerBeginner Swimmer (can swim on front 20ft without flotation)Advanced Swimmer (can pass swim test)
Please list any allergies:
Please list any additional information about your child that would be useful for staff to know, or medication needed during camp day and directions on how to administer it:

Spirit : May 30-June 2
Fitness : Jun 5-9
Myth Busters: Jun 12-16
Select Days: Spirit
Select Days:Fitness
Select Days: Myth
Games Begin: Jun 19-23
Under Sea: Jun 26-30
Holidaze: July 3-7
Select Days:Games
Select Days: Sea
Select Days: Holidaze
Art: Jul 10-14
Olympians: Jul 17-21
Knights: Jul 24-28
Select Days: Art
Select Days: Olympian
Select Days: Knights
Back to School Bash : Jul 31-4
Select Days: Back to School Bash
Will you need before care for any days attending? (Camp director will confirm days).+

YESNOUnsure

Click to add additional camper
Camper 2 Name
Age
Date of Birth

MonthDayYear
Date
T-Shirt Size
Camper Swimming Ability

Non-SwimmerBeginner Swimmer (can swim on front 20ft without flotation)Advanced Swimmer (can pass swim test)
Please list any allergies:
Please list any additional information about your child that would be useful for staff to know, or medication needed during camp day and directions on how to administer it:

Spirit: May 30- 2
Fitness: Jun 5-9
Myth: Jun 12-16
Select Days: Spirit
Select Days: Fitness
Select Days:Myth
Games: Jun 19-23
Sea: Jun 26-30
Holidaze: Jul 3-7
Select Days: Games
Select Days: Sea
Select Days: Holidaze
Art: Jul 10-14
Olympians: Jul 17-21
Knights: Jul 24-28
Select Days: Art!
Select Days: Olympian
Select Days: Knights
Back to Schoo Bash l: Jul 31-4
Select Days: Back to School Bash
Need to add another camper?

Camper 3 Name
Age
Date of Birth

MonthDayYear
Date
T-Shirt Size
Camper Swimming Ability

Non-SwimmerBeginner Swimmer (can swim on front 20ft without flotation)Advanced Swimmer (can pass swim test)
Please list any allergies:
Please list any additional information about your child that would be useful for staff to know, or medication needed during camp day and directions on how to administer it:

Spirit: May 30-3
Fitness: Jun 5-9
Myth: Jun 23-16
Select Days:Spirit
Select Days: Fitness
Select Days: Myth
Games: Jun 19-23
Sea: Jun 26-30
Holidaze: Jul 3-7
Select Days: Games
Select Days: Sea
Select Days: Holidaze
Art: Jul 10-14
Olympians: Jul 17-21
Knights:Jul 24-28
Select Days: Art
Select Days: Olympian
Select Days: Knight
Back to School Bash :Jul 31-4
Select Days:Back to School Bash

Parent/Guardian 1*

First NameLast Name
Relationship to Child*
E-mail*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone*
Home Phone
Work Phone
Where would you like to be reached while your child is at camp?*

Cell PhoneHome PhoneWork Phone
Are you a Member?*

Add additional Parent
Parent/Guardian 2

First NameLast Name
Relationship to Child
E-mail
Cell Phone
Home Phone
Work/School Phone
Home Address Same as Parent/Guardian 1?

Yes
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Where would parent/guardian 2 like to be reached while your child is at camp?

Cell PhoneHome PhoneWork Phone

Parents cannot be listed as emergency contacts. List the name of at least one person who can be contacted in the event of an emergency or illness if you cannot be reached. Any person listed should be able to assist in contacting you. At least one person listed must be within one hour of the center/home, able to take responsibility for the child in case the parent/guardian cannot be contacted and should be at least 18 years of age. The first emergency contact must live no more than 1 hour away and be over the age of 18.
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Secondary Phone Number
Relationship to Child*

Add additional emergency contact
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number
Secondary Phone Number
Relationship to Child

Please list all additional persons authorized to pickup child(ren) other than parents/guardians and emergency contacts.

QR code must be shown in order to signout child(ren)
Name
Relationship
Name
Relationship
Name
Relationship

Please Read the Following Policies Carefully.
Liability Release

I release National Fitness Center, Court South, and its assignees to use the likeness of (e.g group photos of campers, action shots of campers, etc) and quotes by campers for various publications including but not limited to: local newspapers, commercials, nfc1.com, National Fitness Social Media pages, newsletters, and brochures.

IN CONSIDERATION OF BEING ALLOWED TO PARTICIPATE IN ANY OF THE FOLLOWING, PROGRAMS/ACTIVITIES: SWIMMING, MARTIAL ARTS, DANCE, TUMBLING, CHEERLEADING, BASKETBALL COURT ACTIVITIES, AND ANY OTHER SPORT OR FITNESS RELATED EVENT, THE UNDERSIGNED:

Agrees that the parent(s) or legal guardians will instruct the minor participant that prior to participating, he or she should inspect the facilities, class, and equipment to be used, and if the participant believes anything is unsafe, or too difficult, he or she will immediately advise his or her coach/ instructor or supervisor of such conditions and refuse to participate.

Acknowledge and fully understand that each participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which might result not only from their own actions, inactions, or negligence, but also from the actions, inactions, or negligence of others, the rules of play, training, or the conditions of the premises or any equipment used. Furthermore, that there may be other risks not known to us or not reasonably foreseeable at this time.

Assume all the foregoing risks and accept personal responsibility for the damages following such injury, permanent disability, or death.

Release, waive, discharge, and covenant not to sue National Fitness Center, their other affiliated clubs, their respective administrators, directors, agents, coaches, and other employees of the organization, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and leaders of the premises used to conduct the event, all of which are hereinafter referred to as "releases" from any and all liability to each of the undersigned, his or her heirs and next of kin for any and all claims, demands, losses or damages on account of injury including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the release or otherwise.

Realizing that a sudden illness or accident may occur, I hereby ask the Camp Director and Club Manager to use their best judgment in such cases in caring for my child(ren). In the event that I cannot be reached in an emergency, I hereby give permission for National Fitness Center to seek appropriate medical care for my child(ren), including consultation or care by a physician and transportation to a medical care facility/hospital.
Date Signed*

MonthDayYear
Date
How Did You Hear About Us?*
Parent/ Guardian Signature*

Clear
Should be Empty:

Ages 5-12 years old

Monday-Friday 8:30 a.m.- 5:30 p.m.

BEFORE CARE (7:30a.m.- 8:30 a.m.)

Liability Release