2015 Summer Camp Brochure

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.
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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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