Summer Camp Dates and Fees Alice Noble Ice Arena Summer Camp Registration Form: June 8-12 June 15-19 June 22-25 June 29-July 3 July 6-10 July 13-17 July 20-24 July 27-31 Aug 3-7 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 $150.00 *Daily rate is $40.00 per day Camper’s Name: _______________________________ M: __ F:__ Birthday: ________________ Mailing Address: (street, city, state, zip) _____________________________________________ _____________________________________________________________________________ We pride ourselves on a low counselor to camper ratio, providing a positive experience. Mother’s Name: _______________________ Email: ___________________________________ Home Phone: _________________________ Cell Phone: _______________________________ Father’s Name: ________________________ E-mail :___________________________________ Home Phone: _________________________ Cell Phone: _______________________________ Emergency Contact Name: ____________________ Relationship:_______________________ Home Phone: _________________________ Cell Phone: ________________________________ Before and after care is available for an additional fee. Before care begins at 8:00AM and includes breakfast. Aftercare is from 4:00-6:00PM at $5.00 per hour. *Miss Holly’s SUMMER ENRICHMENT* Keep your child’s skills sharp: Reading and Math tutoring, as well as proper letter formation and hand writing. Session is tailored to your child’s needs. Fee paid directly to Miss. Holly. Ice Skating Swimming Yoga Chess Club Golf Bowling Hip-Hop Dance Cooking Class Water Activities Arts and Crafts Weekly Field Trips And Much Much More! Lunch is included in your fee and will be provided daily. The snack bar will be open part of the day for your children to buy additional snacks. Known allergies we should be aware of: _______________________________________________ Any medication that your child is taking: _______________________________________________ Authorized individuals who may pick up your child:________________________________________ Please circle weeks your child will be attending: June 8-12 June 15-19 June 22-26 June 29-July 3 July 6-10- July 13-17 July 20-24 July 27-31 Aug 3-7 Total number of weeks____ x $150 $___________ Total Due ***Sibling discount of $50.00/week when registering more than one child per family per week. ***Sibling discount is not applied to day rates*** Please check if you will need ___ before care (8-9 am $5day) and/or ___aftercare (4-6 pm $5/hour). Before and aftercare fees will be billed separately. Method of Payment: Cash ____ Check Payable to ANIA_____ Credit _____ Credit Card Information - Type of Card: MasterCard ___ Visa ___ Discover ___ Cardholder Name Card # Verification Code Expiration Date Waiver: In consideration of being allowed to participate in any way in Alice Noble Ice Arena (ANIA) Programs, related events and activities, the undersigned acknowledges, understands and agrees that: 1. The risks of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular rules equipment and personal discipline may reduce the risk, the risk of injury does exist and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS INHERENT TO THIS AND ALL RELATED ACTIVITIES AND I ASSUME FULL RESPONSIBILITY FOR MY PARTICIPATION. 3. I willingly agree to comply with the stated and customary terms and conditions for participation. 4. I, for myself and on behalf of heirs, assigns personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS THE ALICE NOBLE ICE ARENA (ANIA), their officers, instructors, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers and, if applicable, owners and leasers of premises used to conduct the event (“Releases”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH or loss or damage to person or property. 5. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGN IT FREELY AND VOLUNTARILY WITHOUT INDUCEMENT. 6. For Participants of Minority Age (under age 18 upon registering This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releases, and for myself, my heirs, assigns and next of kin, I do also release and agree to indemnify the Releases from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided above. FIELD TRIP PERMISSION STATEMENT: I give permission for my child to participate in programs offered at ANIA I waive any liability to ANIA and the staff thereof while participating in these trips or activities. I permit my child(ren) to be transported in a van or walk with authorized personnel. PHOTO RELEASE: I also give permission for my child photograph to be taken while participating at the ANIA. and their activities, to be used for the purpose of publicity. These photos may be used for programs brochures, media productions, advertisements or news articles by ANIA. Signature:___________________________________________________________Date:_________________________ PARENT AUTHORIZATION FORM (If Legal Guardian(s), please indicate status.) Parental permission or power of the guardian is required in hospitals for the following: X-rays and treatment following diagnosis, treatment of all injuries requiring sutures, dressings, medications and surgery. If the parents cannot be contacted, please call Emergency Contact: _____________________________________________ Phone: _____________________________________ Parent/Guardian Signature: ___________________________________________________Date:_____________________________ Participant’s Name: ________________________________________________________ Phone: __________________________ Please list any disabilities, allergies, and/or participation restrictions. __________________________________________________ ____________________________________________________________________________________________________________ Name of Doctor: __________________________________________________Phone: ____________________________________ Name of Dentist: ___________________________________________ ______Phone: ______________________________________ Return thi Woo Summer Camp Alice Noble Ice Arena June 8 – August 7 Summer Camp is held at Alice Noble Ice Arena 851 Oldman Road Wooster, OH 44691 Phone: 330-345-8686 Fax: 330-345-5014 Campers ages 5 to 12 will participate in many different activities: sports, arts & crafts, and entertainment. You are sure to find something you are looking for; Woo Summer Camp has something for everyone. Camp is from 9:00am-4:00 pm Monday-Friday. The camp staff will consist of counselors who have been carefully selected to nurture each child’s experience in a fun, safe, and secure environment. CAMP DIRECTORS: Kaitlyn Marcum Evan McCory Penny H. Vanata Woo Summer Camp is an experience your child will never forget!
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