Get Fit Get Strong 2017 Camp Registration Form
CHILD INFORMATION:
Child Name
*
First Name
Last Name
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
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18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
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2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
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1963
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1961
1960
1959
1958
1957
1956
1955
1954
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1950
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1948
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1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Grade
Name of School
*
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name
*
First Name
Last Name
Relationship
Phone Number
-
Area Code
Phone Number
E-mail
Parent/Guardian Name
First Name
Last Name
Relationship
Phone Number
-
Area Code
Phone Number
E-mail
Please list authorized names to pick up
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
MEDICAL INFORMATION
Physician Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Please List any Allergies, Dietary Restrictions or Medications Needed
Describe any emotional, behavioral, learning or physical disabilities
My Products
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Session 1A: June 26-29
$310.00
$
310.00
Quantity
1
2
3
Item subtotal:
$0.00
$
0.00
Session 1B: Early Drop Off
$25.00
$
25.00
Quantity
1
2
3
Item subtotal:
$0.00
$
0.00
Session 1C: Late Pickup
$25.00
$
25.00
Quantity
1
2
3
Item subtotal:
$0.00
$
0.00
Session 2A: July 24-28
$310.00
$
310.00
Quantity
1
2
3
Item subtotal:
$0.00
$
0.00
Session 2B: Early Drop Off
$25.00
$
25.00
Quantity
1
2
3
Item subtotal:
$0.00
$
0.00
Session 2C: Late Pickup
$25.00
$
25.00
Quantity
1
2
3
Item subtotal:
$0.00
$
0.00
Session 3A: August 7-11
$310.00
$
310.00
Quantity
1
2
3
Item subtotal:
$0.00
$
0.00
Session 3B: Early Drop Off
$25.00
$
25.00
Quantity
1
2
3
Item subtotal:
$0.00
$
0.00
Session 3C: Late Pickup
$25.00
$
25.00
Quantity
1
2
3
Item subtotal:
$0.00
$
0.00
Session 4A: August 21-25
$310.00
$
310.00
Quantity
1
2
3
Session 4B: Early Drop Off
$25.00
$
25.00
Quantity
1
2
3
Item subtotal:
$0.00
$
0.00
Session 4C: Late Pickup
$25.00
$
25.00
Quantity
1
2
3
Item subtotal:
$0.00
$
0.00
Session 5A: August 28-Sept 1
$310.00
$
310.00
Quantity
1
2
3
Item subtotal:
$0.00
$
0.00
Session 5B: Early Drop Off
$25.00
$
25.00
Quantity
1
2
3
Item subtotal:
$0.00
$
0.00
Session 5C: Late Pickup
$25.00
$
25.00
Quantity
1
2
3
Item subtotal:
$0.00
$
0.00
Enter coupon
Apply
Total
$0.00
$
0.00
Payment Preference (Please Check One and we will call you to confirm payment amount and receipt of application)
Pay In Person
Pay by Phone (We will call to confirm registration)
Pay by Mail (Please make checks out to "NovaMMA" and send to 1425 N Quincy Street, Arlington, VA 22207
Other
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