Summer Camp(860) 745-2408
Healthtrax of Enfield
P.O. Box 3500
3 Weymouth Road
Enfield, CT 06082
Summer Camp
(860) 745-2408
Healthtrax of Enfield
P.O. Box 3500
3 Weymouth Road
Enfield, CT 06082
June 23th-August 22 (9 week program)
Note-A minimum of 5 children is required for
camps. We have the right to cancel if this is not met.
Name(s) of
Camper:______________________________________________________
Parents
Name:___________________________________________________________
Camper Age(s): _____ Telephone
#:______________ (Home) _______________ (Cell)
_____
_____ Dates of Camp-
Circle weeks attending
6/23 6/30 7/7 7/14 7/21 7/28 8/4 8/11 8/18 All
Times your camper(s) will attend: (Circle One)
Program 1-MWF 9-12
$90 per week
Program
2-M-F 9-12 $150 per week
Program 3-M-F 9-5 $299 per week
Program 4-MWF 12:30-3:30 $90 per week
Program
2-M-F 12:30-3:30 $150 per week
Emergency Contact Information
Name___________________________
Telephone_________________
Name___________________________
Telephone_________________
RELEASE OF ALL CLAIMS
In consideration of the permission granted to my child to enroll and participate as a student at New England School of Gymnastics. I hereby release and hold harmless the New England School of Gymnastics, Healthtrax, it’s employees, instructors, agents, directors, and officers for any and all claims, demands, liability, harm, injury or damage which may result to my child while enrolled as a student of this school, including all risks connected therewith.
I fully understand that my child/ward _______________ assumes all the risks in connection with enrolling and participating in the activities of this school. I understand that any activity which involves motion, rotation, height or inversion may cause serious accidental injury.
I further certify that my child/ward has undergone a complete physical examination within the last ____ months and that my child/ward is not suffering form any physical condition or disease which might increase the child’s risk of injury or accident by participating in this school.
I have read this release and read all of its terms.
Signed (Parent/Guardian) _________________________________________ Date___________________