Society Skate Camp Registration

Fall Skate Camp Registration
Camper's Information
Last Name*
First Name*
MaleFemale
Address*
City*
State*
Zip*
Birth Date*

MonthDayYear
Grade entering in the fall*

Skater level:

	1	2	3	4	5

1 is Beginner, 5 is Advanced

This fall we are offering many options for Skate Camp due to public, private, charter and Montessori schools having many different dates for Fall Break.

You can sign up for:
- Week - FULL day - 9am - 4pm
- Week - 1/2 day
  - Morning Session 9am-12pm
  - Afternoon Session 1pm-4pm
- You can also PICK your days
  - 1/2 day (morning or afternoon)
  - full-day
We also have options and add-ons available
- Rental equipment (board, helmet & pads)
- Early Drop-off
- Late pick-up
- add lunch
How this form works:

Once your week or pick your own day, a new box will appear to allow you to start picking your options: 1/2 day, morning/afternoon, full-day or select your days.
Week 1 - October 7-11 - 1/2 day Morning SessionWeek 1- October 7-11 - 1/2 day Afternoon SessionWeek 1 - October 7-11 - FULL dayWeek 2 - October 14-18 - 1/2 day Morning SessionWeek 2 - October 14-18 - 1/2 day Afternoon SessionWeek 2 - October 14-18 - Full DayPick my own 1/2 days - MorningPick my own 1/2 days - AfternoonPick my own full days 9am-4pm
10/7 Mon10/8 Tues10/9 Weds10/10 Thurs10/11 Frid10/14 Mon10/15 Tues10/16 Weds10/18 Fri
10/7 Mon10/8 Tues10/9 Weds10/10 Thurs10/11 Frid10/14 Mon10/15 Tues10/16 Weds10/17 Thurs10/18 Fri
10/7 Mon10/8 Tues10/9 Weds10/10 Thurs10/11 Frid10/14 Mon10/15 Tues10/16 Weds10/17 Thurs10/18 Fri
YesNo
Number of days equipment needed ($10/day)
YesNo
Number of days lunch is needed. ($10/day)
YesNo
Early Drop-off: Number of days early drop off is needed
YesNo
Late Pick-up: Number of days late pick-up is needed.
Sub-total of Charges
Parent or Legal Guardian Information
Parent/Legal Guardian*
Relationship*
Cell Phone

Area CodePhone Number
Parent /Legal Guardian 2 or Alternative Pick-Up person*
Cell Phone 2

Area CodePhone Number
Emergency Contact Info
Emergency Contact Name(if parent or guardian is not avaliable)*
Emergency Number*

Area CodePhone Number
Emergency Number #2*

Area CodePhone Number
Email Confirmation
Parents Email (camper confirmation will be sent by email)
example@example.com
How did you hear about Society Skate Camp
Medical Information
Any activity the camper should be restricted from?
Any physical, mental or other condition that would require special attention or medication while at camp? *we cannot give any medications
List any allergies (ex: bees,peanuts, dairy)
Any dietary needs that we should know about?
Camper Photo Release
YesNo
Payment Information
By hitting submit and putting your initials, you agree that you are the parent or legal guardian of the above named camper, and are over the age of 18. In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named camper by authorized personnel. I understand that the above-named camper will only be released to the names listed above, an update may be done at registration. I certify that my child has my permission to attend camp and participate in all activities.
Electronic signature, please initials*
Taxes
Sub-total with Taxes

Total Camp Charges

USDTotal Charges

Credit Card

Should be Empty:

Fall Skate Camp Registration

Camper's Information

Parent or Legal Guardian Information

Emergency Contact Info

Email Confirmation

Medical Information

Camper Photo Release

Payment Information

Credit Card